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 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.
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.
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.
January 20, 2011
Michelle Obama spoke today standing in front of fresh produce at a WalMart. She talked about the initiative that WalMart will undertake to make healthy food more accessible.
WalMart will reduce the sodium in their products and get rid of products with trans fats. They will lower the prices for fresh fruits and vegetables. In short, they will work to make it possible for more of us to afford to eat healthy… Let’s hope it is a model that others follow…
March 1, 2010
As children begin to know about roles and jobs, some will say, “I want to be a doctor.” Their parents buy them a ‘doctor’ kit to play with, and they practice being a doctor. I never hear a child say, “I want to work in public health.” Why is that? What’s wrong with this picture?
Public health isn’t part of the usual high school curriculum, so we don’t get an introduction to what a career in public health might look like. When health education is taught in high school, the course doesn’t introduce students to the public health system. And so, not surprisingly, few of us know what public health is or what the public health system does.
Public health often treats health as a public good. A public good is something for which the benefits for one of us cannot be separated from the benfits for ‘all’ of us. When I get a flu shot, I am supposed to benefit by not getting the flu. But others benefit because they do not get exposed to the flu from me.
So monies spent to inspect restaurants or public pools benefit every member of the public who eats at the restaurants or uses the pools, not just one of them. Monies spent for newborn screening programs benefit all of us because we identify conditions at early stages when prevention or care may limit the harm, and all of us benefit by having a friend or neighbor who can be a healthier and more productive citizen.
School vaccines. Programs for reproductive health. Collection of data about births and deaths–vital statistics that can show patterns and be used to suggest how to improve birth outcomes and decrease deaths. Cancer registries. Programs to prevent disease and accidents. All of these and more are prt of public health’s efforts to promote the public good.
Is the public good “good” for me? Often it is. Sometimes, it may not be.
There are limits to what vaccines I want to be used as gatekeepers to my employment. But there are even more limits to what genetic tests I want to be used as gatekeepers to my free choice to pursue life paths. So the first step is to become aware of what public health means what public does. Then we can advance agendas relating to support for public health and guidelines about where to draw the line in the name of promoting the public’s health.