May 4, 2016
I retired this past year. It is early, but I could, and so I did. Doing so allows me time to pursue projects I could not otherwise have done. It lets me quit worrying about whether I can meet expectations at work. It lets me quit worrying about whether a human resources person will come knocking on my office door to help me see the wisdom of ‘going on disability.’ It removes the anger, frustration, and hostility I felt toward having to repeatedly ask for a classroom in my own building where my office is located and still not getting assigned to such a classroom. It allows me to be an advocate for people living with low vision, to share our experiences, to promote awareness and understanding, to encourage everyone to recognize this largely invisible group of more than 135 million people, and to apply my communication expertise to these goals… In case you were wondering or had already asked me….and even if you weren’t and didn’t…
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.
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.
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.
August 21, 2013
A familiar image. What do you see when you first glance at it? An older woman? A younger woman? Can you see both?
Much of the language being used to define standards for care reminds me of this image. There has been a lot of discussion about an ‘improvement standard’ in the health care arena. The notion is that providers may not cover care if a patient is not expected to have long-term improvement in their medical condition. Some law suits have tackled this issue, especially in relation to paying Medicare.
In one such case, skilled nursing care for a patient was argued to have been denied because the patient was not expected to improve in the long term. In the case of Jimmo vs. Sebelius, the improvement standard was considered and never directly addressed. The decision instead was that skilled care would not be covered when less skilled care would suffice. The Center for Medicare Services declared that they would do an educational campaign to address the issue of the improvement standard. Read more here: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/Downloads/Jimmo-FactSheet.pdf