November 20, 2013
Author: Roxanne
I have always loved to learn. After years of trying to pick a major as an undergraduate, I met a professor who guided me to graduate school. And from graduate school, I learned that I could always go to school and keep on learning. And so I have...
How do different metaphors to define genes relate to understanding?
November 14, 2013
Many of the important messages about health include information about the role of genes for health. Genes matter. Behavior matters. Environments matter. The problem is how to communicate that genes do not absolutely determine health. This will be an important part of health communication for many decades to come.
Professor Celeste Condit wrote about how genes have been defined in her book, “The meanings of the gene” [http://www.amazon.com/The-Meanings-Gene-Heredity-Rhetoric/dp/0299163644].
Efforts to define genes often depend on the use of metaphor, explaining what a gene is in terms of something else that an audience is assumed to already understand. Many of these metaphors use “instruction” as a key component. Professor Rachel Smith and I decided to evaluate two of these instruction metaphors, one that defined genes as “a blueprint of our possibilities” and the other that defined genes in terms of “instructions” more generally. The abstract of the article to be published in February in the journal, Health Communication, appears at: http://www.tandfonline.com/doi/abs/10.1080/10410236.2012.729181#.UtLxv1OFeSo. The online article is at: DOI: 10.1080/10410236.2012.729181
Participants received a message about the role of genes for health for which the introduction varied the definition of a gene, and all other content was the same. Participants who read a message with the blueprint metaphor were more likely to believe that genes absolutely determine health and that genetic therapies are the effective means to address the role of genes for health. The instruction metaphor related to participants having stronger beliefs that genes make one more susceptible to disease but do not absolutely determine the onset of disease, and beliefs that we have some personal control over the role that genes have for our health.
These results support the importance of the metaphors used to define health and scientific terms. Just one exposure to a message that defines genes in different ways can have powerful effects on our attitudes about genes and health.
What is public health?
November 7, 2013
Public Health and Health Insurance as a Public Good: Part 3
October 30, 2013
While the media has given a lot of coverage to citizens complaining about having to pay for health insurance for pregnancy when they are men or have wives past child-bearing age/interest, or for pediatric care, or birth control–the story being lost is the one about health insurance as a public good. If all citizens have access to a certain level of care, then all citizens should achieve a certain level of health, and that should be good for all of us, the public good associated with health insurance and the public’s health.
Of course, we hear these arguments in other contexts. There are people who don’t have children who don’t want to pay for public schools. People who don’t use the interstate system not wanting to pay for maintenance of the interstate system. So it seems to be a very old tune, but the words for the new verse haven’t been rehearsed very well. Without telling more about how sharing the cost of paying for a level of health care aims to benefit all of us, complaints get heard and the argument for the ACA gets lost.
Likely, over time, debates will unfold as data collects to support or fail to support ACA’s benefits for society. Will we improve on some of the major health indicators, such as infant mortality rate–with the U.S. ranking 30th on a recent list [http://www.cbsnews.com/news/us-has-highest-first-day-infant-mortality-out-of-industrialized-world-group-reports/]. That is the hope. It will likely take some discussion and some effort to work toward achieving such aims. And some revision of the ACA. A foundation of understanding related to its purpose is a good place to start.
What is wrong with this picture of the US Public Health Service and commissioned corps?
October 30, 2013
Where is “public health” in the credentialing? While being a civil engineer to work on safe and quality water issues makes sense, many of the issues discussed go beyond the scope of what a civil engineer learns. The passion described for the work being done best fits education in public health. I recommend that the requirements for jobs and internships throughout the US PHS Commissioned Corps site be updated to include requirements related to public health training. These would reflect the IOM report discussed in the last post.
Public Health in the U.S., Public Good, and the Affordable Care Act: Part II
October 20, 2013
Most of us learn at a very young age what “medical doctor” means. Far fewer of us learn what “public health” means. Our nation’s public health system functions largely as a backdrop to promote the well-being of all of us in the U.S. As a member of the Institute of Medicine–IOM–committee that wrote the report, “Who Will Keep the Public Healthy: Educating Public Health Professionals for the 21st Century,” [http://www.iom.edu/Reports/2002/Who-Will-Keep-the-Public-Healthy-Educating-Public-Health-Professionals-for-the-21st-Century.aspx] this reality emerged time and again, as we discussed and debated the roles that the public health force play.
I often teach Korean and Chinese graduate students who look to the U.S. for a model for public health and how to organize and deliver it in their countries where policies are newer and emerging.We tend to take for granted that someone has inspected the safety and health of restaurants where we eat, the meat and produce that we buy to consume, and the water quality coming into our work sites and homes. These “luxuries” sometimes become more salient when we visit outside the boundaries of the U.S. In reality, these illustrate ways that our health is being safeguarded, not only for our individual well-being but for the health of all of us–with inoculations required for public school one of the most recognized acts taken for this aim.
The public good is served when actions are taken to protect and promote the health of each one of us as individuals in order to reduce the likelihood that any one of us will contribute to the illness of others and/or incur costs linked to the poor health of others. This principle frames some of the actions taken as part of the Affordable Care Act but has not been emphasized or clearly explained.
The Public Good, Public Health, and the Affordable Care Act: Part 1
October 10, 2013.
Political discourse related to naming access to health care as a priority shows expansion to the underserved and needy during the era of the Great Society, when Presidents Kennedy and Johnson expanded the social welfare and services system. During this era, the arguments in support of an economic model to support the government’s role in health and health care extended well beyond the need to keep a work force healthy. They included powerless groups, such as the elderly, who needed government assistance. They also included migrant farmworkers who harvest much of the nation’s food but often lack access to health care. Edward Murrow first exposed the conditions in which these laborers exist in the documentary, “Harvest of Shame.”
My first doctoral student to complete her degree as my advisee told me about her mother’s labors in harvesting the nation’s crops in the fields of California. Her mother died at a young age from cancer likely the result of pesticide exposure during those long hours of harvesting.
From a social justice side, it seems only fair to provide care to the nation’s harvesters of food. When that assertion did not work, evidence that a harvester’s poor health and poor sanitation habits–failure to wash hands, for example–could contaminate the food supply was brought forth. This argument relates to public health and the public good, such that safeguarding the health of those who harvest our food benefits everyone’s health. Too little discussed in conversations about affordable health care are the issues related to public health and the public good.
Social Justice, the Unemployed, and the Affordable Care Act: Part 5
October 5, 2013
A fourth event shaping the government’s role in naming access to health and care as political priorities was the Great Depression, 1929-1941. Unemployed workers were unable to pay for their own health care. Because so many workers were unemployed, this led providers’ incomes to fall. Middle class citizens began to rely on public hospitals, and state and local health departments to receive health care. In turn, doctors began providing more services through these venues. Doctors charged the welfare departments. State welfare departments in turn charged the federal government. This cost-shifting system was supported by political priorities established in debates at the federal level and then by passage of such policy as the Social Security Act in 1935.
President Truman expanded Social Security and recommended national health insurance in 1949. He continued to work toward it unsuccessfully until 1953, a year before I was born. Nonetheless, an economic model based on commerce as the stimulus to support a government role in health care access made a transition to a government role in health care access for the needy or underserved with the initial stimulus being the unemployed.
Social Justice, Workers and Congress, and the Affordable Care Act: Part 4
September 30, 2013
It didn’t take long for efforts associated with covering costs associated with worker’s health care to become burdensome. In 1927, the Congressional Committee on Costs of Medical Care proposed Health Maintenance Organizations [HMOs] as a strategy aimed at providing affordable health care to all citizens. A minority report written by doctors and adopted by the American Medical Association, however, took the position that HMOs would hurt the quality of health care. As a result, the Committee’s recommendation was not seriously considered.
Congress initiated a program for its own health care in 1928. In response to a number of elected lawmakers collapsing and even dying while on duty that year, Congress asked the Navy to provide a physician for the Capitol. The Office of the Attending Physician provides some basic care to members at a cost of about $500 a year, the same rate that has been in place since 1992. The budget for the Office of the Attending Physician is more than $3 million [http://thomas.loc.gov/cgi-bin/cpquery/?&sid=cp113l8f0T&r_n=hr173.113&dbname=cp113&&sel=TOC_22349]. There are several Navy doctors providing the care, together with more than a dozen registered nurses. The budget also includes a pharmacist, an ambulance available at the steps of the Capitol building, plus first-aid stations that staff members may use, and the x-ray and lab equipment available for care. In addition, care for families of Congress comprises choices much like all of us must make [http://jeffduncan.house.gov/legislative-work/fact-or-fiction/fact-or-fiction-do-members-congress-get-free-health-care].
Social Justice, Workers, and the Affordable Care Act: Part 3
September 25, 2013
In the first two decades of the 20th century, middle class progressives realized that the American industrial society’s working-class citizens suffered ill health and injury through no fault of their own. Work places were often unsafe, causing injury to workers and their ability to work. In recognition of these facts, a number of economists formed the American Association for Labor Legislation (AALL) in 1905 for the purpose of studying labor conditions and labor legislation [see http://www.proquest.com/en-US/catalogs/collections/detail/American-Association-for-Labor-Legislation-38.shtml].
The AALL group advocated for health reforms in industry and sought compulsory health insurance. Initial efforts to argue the merits of such legislation focused on workmen’s compensation. This strategy aimed to provide access to care for workers injured on the job.
Woodrow Wilson joined the AALL [http://www.ssa.gov/history/corningchap1.html]. He included their social insurance plank in the 1912 Progressive party’s platform. In 1915, the AALL published a model health insurance bill in legislative language to be considered by State legislatures, with California, Massachusetts, and New Jersey supporting the proposal out of the 12 States that discussed it. As debate continued within the States, so did opposition to a proposal for government health insurance. AALL leaders assumed that such reform would be viewed as beneficial to all. The stage was set for health insurance to dominate conversations about health care.
