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.
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.
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].
One of my sister’s brought to my attention some research about ‘forest therapy’. I read the article she sent me and was pleased to find that basking in the surroundings of a forest was reported to have positive benefits for human health. I would have to say that I didn’t need any justification for spending time in nature any opportunity that I get, but it was a nice thought to justify my own love of nature.
And then I decided to go on a hunt for the research. Alas, as is too often the case, there was no mention of the actual publication in the news report and so I had to go in search of the research. On PUBMED, I was able to find research on ‘forest therapy’. Sadly, the most recent article–published in the past several months in 2012, is a meta-analysis that examined all previously published articles and concludes that there is no evidence from which to draw conclusions about the effects of forest therapy [see http://www.ncbi.nlm.nih.gov/pubmed/22888281]. The authors conclude that, “Because there was insufficient evidence on forest therapy due to poor methodological and reporting quality and heterogeneity of RCTs, it was not possible to offer any conclusions about the effects of this intervention. However, it was possible to identify problems with current RCTs of forest therapy, and to propose a strategy for strengthening study quality and stressing the importance of study feasibility and original check items based on characteristics of forest therapy as a future research agenda.”
Alas, I remain steadfast in my belief that forest therapy, spending time walking and living and breathing in forest environments, sustains me. But I have at least one very good and close longtime friend who would not agree with me. She basks in the bright lights and fast pace of locations such as New York city in December. That, in fact, was one of the challenges associated with the research. There are unpleasant forest setings that no one would want to spend time in, so not all forests are created equal. And there has to be a great deal of individual variance related to preferences in this regard. Perhaps it is more important to communicate that each of us should take time to identify what environment and setting gives us the most calm and promotes our well-being. And then find time to bask in it.
Disney has decided to ban ads for junk food when it comes to kids’ cartoons. That’s some good news when it comes to media exposure and kids’ learning product names. The bad news is that it won’t take effect until 2015. Wow. Why? Contracts?
Read more in the AP story here: http://www.registerguard.com/web/business/28184338-41/disney-ads-junk-ban-sugar.html.csp
Dick Clark died today. I was reminded of how much music benefits our health. Here is a link to a summary of some of that research: http://www.designandhealth.com/uploaded/documents/
publications/papers/paul-robertson-wcdh2000.pdf. It says that music can reduce pain…all kinds of pain. Thank you Dick Clark for lessening our pain… all kinds of pain.
It is a fascinating history filling volumes of research journals and books and ledgers… The tobacco settlement… It came to my attention again today as I was reading about Pennsylvania’s adult basic health insurance program.
Mostly, in the past several days, I’ve heard sound bites about the program shutting down and leaving Pennsylvanians uninsured. The shutdown in the stories I’ve heard seemed to be linked to state budgets and all that is going on there. Today, I had a moment to explore more about these soundbites and learned that…the program began under Governor Tom Ridge who used the State’s tobacco settlement funds [http://onevoicetulsa.com/index.php?ht=display/ContentDetails/i/4424680].
One might ask how we get from the the latter to the former? We all share higher health care costs linked to smoking…whether or not we smoke or have smoked. So perhaps it was a creative and even equitable program that the former governor introduced…