Health, Culture, and Society @ Broome

Hey HSHers,

For those of you wondering about community service oppurtunities, this the event for you!! Holly, the RA of the Gender and Sexuality Stream and I are working together with FFiR Stephanie Smith-Waterman on the AVON Walk for Breast Cancer. We'd be glad if you could join us- read on for details!

-Dina

The AVON Walk for Breast Cancer

Come Volunteer with us at the North Moore Cheering Station

For the 3rd Year in a row, GLWD and NYu will be celebrating the accomplishements of all the participants at the AVON Walk for Breast Cancer. Join Us!


WHEN: Saturday , October 6th ; Meet at the Broome Street Lobby at 8AM !!!

WHERE: North Moore St. at the Hudson River

WEAR: FREE T-Shirts for All!

WHAT: We will distribute brownies, cheer folks on with clappers and ask participants to sign a commermorative banner!


TO SIGN UP : PLEASE CONTACT Stephanie Smith-Waterman, Faculty-Fellow-in-Residence at ssw228@nyu.edu

August 29, 2007
Frontline Report: Childhood Asthma
For Minority Kids, No Room to Breathe
By ALIYAH BARUCHIN

Among Americans with asthma, minority children are in by far the worst situation. The numbers are striking: in the United States, 20 percent of Puerto Rican children, or one in five, have asthma. Among African-American youngsters, the rate is 13 percent, compared with the national childhood average of 8 percent. In addition, since 1999 asthma-related mortality rates have dropped for Americans as a whole, but not for minority children.

According to the National Center for Health Statistics, African-American and Puerto Rican children are six times as likely as white children to die of asthma. In minority children, “the prevalence of asthma is about 40 percent higher, but the difference in the adverse outcomes is three times, four times higher for hospitalizations,” said Dr. Lara Akinbami, a researcher at the center who tracks childhood asthma. “Given that we have the tools to prevent those things, that does reach the level of a public health crisis.”

Several factors contribute to the disparity. Socioeconomic status is certainly central, particularly in terms of environment. Children in poor inner-city communities are disproportionately exposed to both indoor and outdoor allergens — cockroaches, mice, mold, dust, cigarette smoke, automobile exhaust, soot — that can trigger breathing problems.

“If you look at inner-city children, they’re sensitized to more allergens and exposed to more allergens at higher levels in their homes, allergens that it’s difficult for them to avoid,” said Dr. Andrew Liu of the National Jewish Medical and Research Center in Denver. Dr. Liu is part of the Inner-City Asthma Consortium, a federally sponsored research initiative at 10 medical centers nationwide that looks at the severity of asthma in cities and is testing treatments to block the allergic response.

Chronic lack of access to outpatient health care and the poorer quality of care in inner-city neighborhoods is another crucial factor. Successful asthma care depends on regular medical maintenance, and poor urban children have less reliable access to doctors’ offices and clinics, more often relying on emergency room visits for treatment.

More generally, keeping up with treatment can be daunting for anyone. “Asthma is a very high-maintenance disease,” Dr. Akinbami said. “You can really control it and live without symptoms, but it’s a lot of work. And if you have a lot of other challenges, it’s much harder to really get organized and motivated to do the things that are necessary.”

Patterns of medication use may differ as well. Inner-city children with asthma tend to overuse fast-acting rescue medications like albuterol at the expense of long-acting steroids like Flovent or Pulmicort, mainstays of asthma control. Language and other social barriers often prevent doctors from accurately assessing how asthma patients are using their medicines at home.

Genetic factors may also play a role. African-Americans are more likely to have a genetic characteristic that makes them more vulnerable to the adverse effects of overusing rescue medications. And even after controlling for socioeconomic factors, African-American children tend to have higher levels of allergies, which are related to asthma in about 85 percent of cases, than white children. Among Puerto Rican children, the incidence of asthma is equally high both in mainland cities and on the island of Puerto Rico, pointing to a possible genetic predisposition to developing the disease.

But at the moment, genetics is secondary to the pressing need for quality care. Several city-based or regional asthma intervention programs have had significant success in raising awareness among parents and doctors, reducing exposure to allergens in homes and schools, and improving care for children.

From 1997 to 2001 during New York City’s Childhood Asthma Initiative — which ran the memorable “I have asthma, but asthma doesn’t have me” advertising campaign — the rate of childhood hospitalizations for asthma in the city decreased by more than a third. The rates of emergency room visits and hospital stays have decreased sharply in central Connecticut, which has the Easy Breathing program to teach practitioners how to more accurately identify asthma in children and meet National Institutes of Health guidelines for care.

At the end of the day, what makes the statistics about minority children and asthma remarkable is that there is actually no mystery to asthma management. Successful intervention programs are straightforward, fact-based and, in theory, easily replicated.

“Even though we don’t know how to prevent asthma, we really do know how to control the symptoms,” Dr. Akinbami said. “These programs can make a difference, and change the outcomes for these children.”
Published August 30, 2007.

Gaza





Afghanistan

Cases of Cholera Reach Baghdad
By ANDREW E. KRAMER

BAGHDAD, Sept. 20 — The first cases of cholera appeared in Baghdad on Thursday, in a sign the epidemic that has already sickened thousands in northern Iraq is now spreading more widely in a population made vulnerable by war to a normally preventable disease.

The World Health Organization and Iraqi Red Crescent Society reported two cases here and Iraqi television reported another case, in a 7-month-old baby, in Basra, far to the south.

People contract cholera by ingesting water or food contaminated with the feces of an infected person. Roughly one in 20 infected people become severely ill, with profuse diarrhea, vomiting and leg cramps, while others have mild or no symptoms but carry the disease.

While cholera can kill its victims in a matter or hours, it is easily controlled through basic water treatment and sanitation measures. But in a sign of how difficult that may be in Iraq, the director of the Basra health ministry, Dr. Ryadh Abdul Ameer, said Thursday that some waterworks in his city were now entirely without chlorine, which is used to purify, because imports of chlorine dried up this year after insurgents used the chemical in bomb attacks.

“We are suffering from a shortage of chlorine, which is sometimes zero,” Dr. Ameer said in an interview on Al Hurra, an American-financed television network in the Middle East. “Chlorine is essential to disinfect the water.”

The cholera outbreak in Iraq this summer had been centered near Kirkuk and Sulaimaniya, in Kurdistan, where at least 10 people have died. In a report released Sept. 14, the W.H.O. said that cholera had been clinically confirmed in more than 1,055 cases so far in Kurdistan and was suspected in more than 24,500 cases of diarrhea and vomiting. In Baghdad, the W.H.O. representative for Iraq, Dr. Naeema al-Gasseer, said laboratory tests confirmed one 25-year-old woman had contracted the disease; a second case was suspected but not confirmed, she said. A hospital worker in the Sadr City area of eastern Baghdad said one patient there appeared to be sick with cholera. That case also was not confirmed.

Cholera is not uncommon in Iraq, which typically reports around 30 cases a year, public health experts say, with the last major outbreak coming in 1999. While it can be stopped with warnings and basic precautions like boiling water, it has crept south through the tumultuous Diyala region, which has been convulsed in sectarian conflict.

Hospital sources there reported two cases on Thursday, after cholera had earlier turned up on the northern border of Diyala, closer to the Kurdish outbreak.

The Iraqi deputy health minister, Dr. Adel Mohsin, said that he knew of only one confirmed case of cholera in Baghdad, and that was in a patient who lived in an outlying district near Diyala Province, called Diyala Bridge, rather than within the city.

Cholera is caused by an infection of the intestines from contaminated water. Dr. Said Hakki, the director of the Iraqi Red Crescent, said earlier that health officials expected the disease to break out in Baghdad by late September or early October. If it is widespread, the security situation could make it extremely difficult to send in health workers to protect the population.

At a briefing Thursday, Lt. Gen. Raymond T. Odierno, the second-ranking commander in Iraq, and an Iraqi commander, Lt. Gen. Qanbar Abud, who is in charge of Baghdad operations for the Iraqi Army, said violence in the capital had dropped off sharply this year during the buildup of American troops. Civilian casualties in Baghdad dropped to 12 per day from 32 per day, he said.

Also on Thursday, the BBC sent a memo to its employees around the world stating that because of a threat received by the BBC’s Baghdad bureau, the network would temporarily move the newsgathering staff out of that bureau to unspecified locations.

“We’ve been made aware of a specific threat to the international staff in the Baghdad bureau,” said the memo, sent by Jon Williams, the BBC’s World News editor.

The memo said that the BBC’s coverage of Iraq would continue with “a significantly reduced team” while the security threat was assessed. No other details were given, but the memo from Mr. Williams said there had been a meeting with Iraqi and Western staff members in Baghdad, “and we have reassured them that this is a temporary move and that their safety is our only concern.”

Reporting was contributed by Ahmad Fadam, Sahar Najeeb, Ali Fahim, Mudhafar Fadhil and other Iraqi employees of The New York Times.

Sunday, September 23: I'll be going to a 10 a.m. Kundalini yoga class directly across the street from the dorms. Please email me by Saturday late afternoon if you would like to join, and we can plan on a time to meet. I'll also be wandering around Soho for a bit after class. Let me know if you might want to wander with me and find a cup of tea around 11:30ish.

Saturday, September 29: NEW YORK UNIVERSITY, “The Pencil Lets You Say What the Mouth Does Not” Saturday at 4 o’clock. 19 West 4th Street (the corner of Mercer and West 4th). Room 102. Co-sponsored by The International Society for the Psychological Treatments of the Schizophrenias and Other Psychoses and the NYU Postdoctoral Program. 212-533-5687 for more info.

Monday, October 1: STREAM EVENT: Smoothie Making Workshop (& perhaps a poem or two) in the Broome Room. 7:30.

Tuesday, October 9: "Dead Mums Don't Cry": Averting Maternal Death and Disability in Africa. 7:00 - 9:00pm. NYU Cantor Film Center. Theater 101. 36 East 8th Street, NYC. Please RSVP online for this event by visiting http://www.nyu.edu/mph/events/.

Wednesday, October 10: STREAM EVENT: "Hotel Cassiopeia;" 6 p.m. at BAM in Brooklyn. We have a limited number of tickets to this show so please let me know if you'd like to come.

Monday, October 29: STREAM EVENT: Felice Aull to speak in the Broome Room. 7:30.

Tuesday October 30 – THE PHILOCTETES CENTER, “Poetry in the Therapeutic Context” Roundtable with Michael Braziller and Madge McKeithen. 247 East 82 Street 3rd Floor, New York, New York Tuesday from 7-9. 646-422-0544

Here's a rough list of HSH programs this semester. We will be adding more programs as we go along, so make sure to check back for updates.


September 20--Perry Klass at Smilow Multipurpose Room, 5-7 (NYU Medical)

October 1--Poetry Workshop/Roundtable at Broome Street, 7:30

October 10--Hotel Cassiopeia @ BAM, 6:00

October 29--Felice Aull to speak at Broome Street, 7:30

November 14--De-stress Yoga/Alternative Medicine, meet at Broome Street

November 26--Madge McKeithen to speak at Broome Street, 7:30

December 12--Final Meal @ Spring Street Natural

rom the NYT, 8.12.07



August 12, 2007

Editorial

World’s Best Medical Care?
Many Americans are under the delusion that we have “the best health care system in the world,” as President Bush sees it, or provide the “best medical care in the world,” as Rudolph Giuliani declared last week. That may be true at many top medical centers. But the disturbing truth is that this country lags well behind other advanced nations in delivering timely and effective care.

Michael Moore struck a nerve in his new documentary, “Sicko,” when he extolled the virtues of the government-run health care systems in France, England, Canada and even Cuba while deploring the failures of the largely private insurance system in this country. There is no question that Mr. Moore overstated his case by making foreign systems look almost flawless. But there is a growing body of evidence that, by an array of pertinent yardsticks, the United States is a laggard not a leader in providing good medical care.

Seven years ago, the World Health Organization made the first major effort to rank the health systems of 191 nations. France and Italy took the top two spots; the United States was a dismal 37th. More recently, the highly regarded Commonwealth Fund has pioneered in comparing the United States with other advanced nations through surveys of patients and doctors and analysis of other data. Its latest report, issued in May, ranked the United States last or next-to-last compared with five other nations — Australia, Canada, Germany, New Zealand and the United Kingdom — on most measures of performance, including quality of care and access to it. Other comparative studies also put the United States in a relatively bad light.

Insurance coverage. All other major industrialized nations provide universal health coverage, and most of them have comprehensive benefit packages with no cost-sharing by the patients. The United States, to its shame, has some 45 million people without health insurance and many more millions who have poor coverage. Although the president has blithely said that these people can always get treatment in an emergency room, many studies have shown that people without insurance postpone treatment until a minor illness becomes worse, harming their own health and imposing greater costs.

Access. Citizens abroad often face long waits before they can get to see a specialist or undergo elective surgery. Americans typically get prompter attention, although Germany does better. The real barriers here are the costs facing low-income people without insurance or with skimpy coverage. But even Americans with above-average incomes find it more difficult than their counterparts abroad to get care on nights or weekends without going to an emergency room, and many report having to wait six days or more for an appointment with their own doctors.

Fairness. The United States ranks dead last on almost all measures of equity because we have the greatest disparity in the quality of care given to richer and poorer citizens. Americans with below-average incomes are much less likely than their counterparts in other industrialized nations to see a doctor when sick, to fill prescriptions or to get needed tests and follow-up care.

Healthy lives. We have known for years that America has a high infant mortality rate, so it is no surprise that we rank last among 23 nations by that yardstick. But the problem is much broader. We rank near the bottom in healthy life expectancy at age 60, and 15th among 19 countries in deaths from a wide range of illnesses that would not have been fatal if treated with timely and effective care. The good news is that we have done a better job than other industrialized nations in reducing smoking. The bad news is that our obesity epidemic is the worst in the world.

Quality. In a comparison with five other countries, the Commonwealth Fund ranked the United States first in providing the “right care” for a given condition as defined by standard clinical guidelines and gave it especially high marks for preventive care, like Pap smears and mammograms to detect early-stage cancers, and blood tests and cholesterol checks for hypertensive patients. But we scored poorly in coordinating the care of chronically ill patients, in protecting the safety of patients, and in meeting their needs and preferences, which drove our overall quality rating down to last place. American doctors and hospitals kill patients through surgical and medical mistakes more often than their counterparts in other industrialized nations.

Life and death. In a comparison of five countries, the United States had the best survival rate for breast cancer, second best for cervical cancer and childhood leukemia, worst for kidney transplants, and almost-worst for liver transplants and colorectal cancer. In an eight-country comparison, the United States ranked last in years of potential life lost to circulatory diseases, respiratory diseases and diabetes and had the second highest death rate from bronchitis, asthma and emphysema. Although several factors can affect these results, it seems likely that the quality of care delivered was a significant contributor.

Patient satisfaction. Despite the declarations of their political leaders, many Americans hold surprisingly negative views of their health care system. Polls in Europe and North America seven to nine years ago found that only 40 percent of Americans were satisfied with the nation’s health care system, placing us 14th out of 17 countries. In recent Commonwealth Fund surveys of five countries, American attitudes stand out as the most negative, with a third of the adults surveyed calling for rebuilding the entire system, compared with only 13 percent who feel that way in Britain and 14 percent in Canada.

That may be because Americans face higher out-of-pocket costs than citizens elsewhere, are less apt to have a long-term doctor, less able to see a doctor on the same day when sick, and less apt to get their questions answered or receive clear instructions from a doctor. On the other hand, Gallup polls in recent years have shown that three-quarters of the respondents in the United States, in Canada and in Britain rate their personal care as excellent or good, so it could be hard to motivate these people for the wholesale change sought by the disaffected.

Use of information technology. Shockingly, despite our vaunted prowess in computers, software and the Internet, much of our health care system is still operating in the dark ages of paper records and handwritten scrawls. American primary care doctors lag years behind doctors in other advanced nations in adopting electronic medical records or prescribing medications electronically. This makes it harder to coordinate care, spot errors and adhere to standard clinical guidelines.

Top-of-the-line care. Despite our poor showing in many international comparisons, it is doubtful that many Americans, faced with a life-threatening illness, would rather be treated elsewhere. We tend to think that our very best medical centers are the best in the world. But whether this is a realistic assessment or merely a cultural preference for the home team is difficult to say. Only when better measures of clinical excellence are developed will discerning medical shoppers know for sure who is the best of the best.

•

With health care emerging as a major issue in the presidential campaign and in Congress, it will be important to get beyond empty boasts that this country has “the best health care system in the world” and turn instead to fixing its very real defects. The main goal should be to reduce the huge number of uninsured, who are a major reason for our poor standing globally. But there is also plenty of room to improve our coordination of care, our use of computerized records, communications between doctors and patients, and dozens of other factors that impair the quality of care. The world’s most powerful economy should be able to provide a health care system that really is the best.