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Public Health, Environmental Health, and Activism

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Title: Public Health, Environmental Health, and Activism


1
Public Health, Environmental Health, and Activism
  • Martin Donohoe

2
Am I Stoned?
  • A 1999 Utah anti-drug pamphlet warns
  • Danger signs that your child may be smoking
    marijuana include excessive preoccupation with
    social causes, race relations, and environmental
    issues

3
Schism between medical schools and schools of
public health
  • Dates back to the early twentieth century
  • Medical schools more focused on biochemical
    mechanisms of disease and drug therapies
  • Public health focused on populations and societal
    issues
  • Few contemporary physicians have public health
    training

4
Important Contributions of Public Health
  • Water and food safety
  • Sanitation
  • Vaccination
  • Fluoridation
  • Iodine supplementation of table salt
  • Seat belts, air bags
  • Bed nets for malaria prevention
  • Barriers to decrease bridge suicides

5
Reasons for Underfunding of Public Health (NEJM
362181657-8)
  • Benefits of public health programs lie in the
    future
  • Beneficiaries of public health measures are
    generally unknown
  • Benefactors are often unknown
  • Opposition to public health programs often
    political, corporate
  • Medical care usually promoted by corporate
    interests

6
Medical Ethics Today
  • Overemphasizes individual conflicts and
    fascinating dilemmas involving expensive
    technologies (e.g., gene therapy, cloning, face
    transplants)
  • Underemphasizes the psychological, cultural,
    socioeconomic, occupational, and environmental
    contributors to health

7
The State of U.S. Health Care
  • 51 million uninsured patients
  • Millions more underinsured
  • Remain in dead-end jobs
  • Go without needed prescriptions due to
    skyrocketing drug prices
  • Est. 51,000 deaths/year due to lack of health
    insurance

8
The State of U.S. Health Care
  • US ranks near the bottom among westernized
    nations in life expectancy and infant mortality
  • 20-25 of US children live in poverty
  • Gap between rich and poor widening
  • Racial inequalities in processes and outcomes of
    care persist

9
Headline from The Onion
  • Uninsured Man Hopes His Symptoms Diagnosed This
    Week On House

10
Maldistribution of Wealth
  • U.S Richest 1 of the population owns 50 of
    the countrys wealth poorest 90 own 30
  • Widest gap of any industrialized nation

11
Maldistribution of Wealth
  • Less than 4 of the combined wealth of the 225
    richest individuals in the world would pay for
    ongoing access to basic education, health care,
    adequate food, safe water, and adequate
    sanitation for all humans (UNDP)

12
Overconsumption (Affluenza)
  • U.S. 6.3 of worlds population
  • Owns 50 of the worlds wealth
  • U.S. responsible for
  • 25 of worlds energy consumption
  • 33 of paper use
  • 72 of hazardous waste production

13
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14
Income Inequality
  • Lower life expectancy
  • Higher rates of infant and child mortality
  • Short height
  • Poor self-reported health
  • AIDS
  • Depression
  • Mental Illness
  • Obesity

15
Voltaire
  • The comfort of the rich rests upon an abundance
    of the poor

16
George Orwell
  • Some people are more equal than others

17
Hudson River, 2009
18
Racial Disparities in Health CareAfrican-America
ns
  • Higher maternal and infant mortality
  • Higher death rates for most diseases
  • Shorter life expectancies
  • Less health insurance
  • Undergo fewer diagnostic tests / therapeutic
    procedures

19
Racial Disparities in Health CareAfrican-America
ns
  • Equalizing the mortality rates of whites and
    African-Americans would have averted 686,202
    deaths between 1991 and 2000
  • Whereas medical advances averted 176,633 deaths
  • AJPH 2004942078-2081

20
Primo Levi
  • A country is considered the more civilized the
    more the wisdom and efficiency of its laws hinder
    a weak man from becoming too weak or a powerful
    one too powerful.

21
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22
Meanwhile, Outside the US
  • 1 billion people lack access to clean drinking
    water
  • 3 billion lack adequate sanitation services
  • Hunger kills as many individuals in two days as
    died during the atomic bombing of Hiroshima

23
James Nachtwey
24
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25
Competitive Strategies of Financially-Strapped
Academic Medical Centers
  • Tuition hikes (?rising medical student debt)
  • Close public and charity hospitals
  • Single specialty hospitals

26
Competitive Strategies of Financially-Strapped
Academic Medical Centers
  • Recruit wealthy, non-U.S. citizens as patients
  • More aggressive billing practices / charging the
    uninsured higher prices

27
Competitive Strategies of Financially-Strapped
Academic Medical Centers
  • Increase cash services (botox treatments,
    cosmetic surgery) and reimburseable, covered
    services (e.g., cardiac catheterization, bone
    density testing)
  • Pay sports teams for privilege of being team
    doctors (in return for free publicity)
  • Develop luxury primary care clinics

28
The Medical Brain Drain
  • Five times as many migrating doctors flow from
    developing to developed nations than in the
    opposite direction
  • Example of inverse care law
  • Those countries that need the most health care
    resources are getting the least

29
Rudolph Virchow
  • Doctors are natural attorneys for the poor If
    medicine is to really accomplish its great task,
    it must intervene in political and social life

30
Jacob Riis
31
Dorothea Lange
32
Care for All Equally
  • A society should be judged not by how it treats
    its outstanding citizens but by how it treats its
    criminals
  • -Fyodor Dostoyevsky

33
  • PROBLEMS
  • And
  • SOLUTIONS

34
Colonial Exploitation
  • Christopher Columbus log entry upon meeting the
    Arawaks of the Bahamas
  • Theybrought usmanythingsThey willingly
    traded everything they ownedThey do not bear
    armsThey would make fine servantsWith fifty men
    we could subjugate them all and make them do
    whatever we want.

35
Colonial Exploitation
  • Cecil Rhodes (Rhodesia, Rhodes Scholarship,
    DeBeers Mining Company)
  • We must find new lands from which we can easily
    obtain raw materials and at the same time exploit
    the cheap slave labour that is available from the
    natives of the colonies. The colonies would also
    provide a dumping ground for the surplus goods
    produced in our factories.

36
Sebastiao Salgado
37
Exploitation leads to
  • Maldistribution of wealth and resources
  • Environmental degradation
  • Wars
  • Over 250 wars in 20th Century
  • Most deaths among civilians
  • Militarism and war divert financial and
    intellectual resources away from social needs
  • Weapons of mass destruction

38
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39
Contemporary Research Imbalances and Exploitation
  • Unethical research on special populations
    (cultural minorities, prisoners, developing
    world, etc.)
  • Majority of phase 3 US drug company trial sites
    outside US, many in developing countries
  • 90 of research dollars spent on diseases
    affecting 10 of the worlds population
  • Limited access of developing world to results due
    to scarcity of open-access publications

40
Womens Health
  • Political, legal, and educational marginalization
  • Violence
  • Impaired access to reproductive health care
  • Female genital cutting

41
Status of Women
  • Economic discrimination
  • Women do 67 of the worlds work
  • Receive 10 of global income
  • Own 1 of all property
  • A woman in a developing country walks an average
    of 6 km/day to obtain water
  • Heavy exposure to indoor biomass cooking stoves

42
Environmental Degradation Pollution
  • Air pollution causes approximately 60,000 -
    75,000 premature deaths/yr. in U.S., 1.8 million
    worldwide
  • NAS Pesticides in food could cause up to 1
    million cancers in the current generation of
    Americans

43
Air Pollution
44
Air Pollution
45
Environmental DegradationToxic Exposures
  • 13,000-15,000 deaths per day worldwide from
    water-related diseases
  • In developing countries, 90-95 of sewage and 70
    of industrial wastes are dumped untreated into
    the local water supply
  • 1 in 4 U.S. citizens lives within 4 miles of a
    Superfund site
  • Lead and mercury exposure multi-billion dollar
    problems

46
Water PollutionBathtubToiletSource of
Drinking Water
47
ToxinsMinimata Disease - W Eugene Smith
48
Environmental Degradation Deforestation
49
Greenlands Ice Cap Melting 1992
50
Greenlands Ice Cap Melting 2002
51
Greenlands Ice Cap Melting 2005
52
Climate Change Drought
53
Agriculture
  • Commodification of worlds food and water supply
    by corporations
  • Spread of GMOs and Biopharming
  • Factory farms
  • 1 polluters of American waterways
  • Agriculture accounts for 70 of U.S. antibiotic
    use
  • 1 contributor to food-borne, antibiotic-resistant
    infections (CDC)

54
Factory Farming
55
OverfishingFactory Trawlers
56
Dynamite Reef Fishing
57
Environmental Degradation Species Loss
  • Largest mass extinction since the demise of the
    dinosaurs 65 million yrs ago
  • Lost Pharmacopoeia
  • More than 1/2 of the top 150 prescription drugs
    contain an active compound derived from or
    patterned after natural products-e.g. digoxin,
    vincristine, paralytic agents, etc.
  • Of the more than 250,000 known flowering species,
    lt0.5 have been surveyed for medicinal value

58
A Cure for Cancer?
59
War and Militarism
  • Diversion of economic resources and intellectual
    capital
  • Military worlds largest polluter
  • Prejudice/hate crimes
  • Erosion of civil liberties
  • Weapons of mass destruction

60
2009 Federal Budget2.65 trillion
61
The Military Diversion of Resources Away from
Health Care
  • 3 hours world arms spending annual WHO budget
  • 3 weeks of world arms spending/yr. primary
    health care for all in poor countries, incl. safe
    water and full immunizations

62
War and Peace
  • World military budget 1,470 billion in 2008
  • 190X what the UN spends on peacekeeping
  • US
  • Largest military budget, largest arms supplier
  • Greatest debtor to UN peacekeeping fund

63
  • Every gun that is made, every warship launched,
    every rocket fired, signifies in the final sense
    a theft from those who hunger and are not fed,
    those who are cold and not clothed.
  • Dwight D. Eisenhower

64
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65
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66
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67
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68
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69
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70
Kuwaiti Oil Fires Gulf War I
71
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72
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73
Impediments to Public Health and Social Justice
  • Political climate
  • Scientific Ignorance
  • Pseudoscience
  • Damaged educational system
  • The corporate media
  • All lead to the decline of democracy

74
Bush Administration
  • Key administrators/committee members/regulators
    former industry representatives and/or lobbyists
  • Privatization of public services
  • Corporate profit before public good
  • Unsound/distorted/suppressed science

75
Bush Administration
  • Rollbacks of key environmental laws
  • Lax enforcement of existing laws
  • Huge tax cuts primarily benefit wealthy
  • Federal and state government deficits
    astronomical
  • Program and funding cuts
  • Trade deficit increased

76
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77
Obama Administration
  • Overturns global gag rule
  • Some improvements in FDA, EPA
  • Withdrawal (partial) from Iraq
  • Failure to consider single payer health care
  • Supports genetically-modified crops
  • Appointees holdovers (philosophically and
    personally) from prior administrations
  • ?The future?

78
Would You Sign a Petition to Ban Dihydrogen
Monoxide?
  • 1. It can cause excessive sweating and
    vomiting2. It is a major component in acid
    rain3. It can cause severe burns in its gaseous
    state4. It can kill you if accidentally
    inhaled5. It contributes to erosion6. It
    decreases effectiveness of automobile brakes7.
    It has been found in tumors of terminal cancer
    patients

79
Environmental and Geographic Ignorance
  • A majority of Americans believe that electricity
    in the U.S. is produced in nonpolluting ways
  • 25 knew that majority (70) comes from oil,
    coal and wood
  • Percent of US teens unable to locate the
    following on a map
  • United States 11
  • Pacific Ocean 29
  • Japan 58

80
Contributors to Poor Education
  • U.S. public education system in disarray
  • Mass media consolidation, corporate influence

81
Television
  • The average American youth spends 900 hrs/yr in
    school, 1,500 hrs/yr watching TV
  • By age 65, the average American will have spent 9
    yrs watching TV
  • Contributor to obesity epidemic

82
Global Warming Controversial?
  • Of 928 articles in peer-reviewed scientific
    journals, 0 were in doubt as to the existence or
    cause of global warming
  • Of 636 articles in the popular press (NY Times,
    Washington Post, LA Times, WSJ), 53 expressed
    doubt as to the existence (and primary cause) of
    global warming
  • Science 20043061686-7
  • (Study covers 1993-2003)

83
Global Warming
  • Causes estimated 160,000 deaths and 5.5 million
    disability-adjusted life years lost per year
  • WHO, UN Environment Program

84
Corporations Dominate the Global Economy
  • 53 of the worlds 100 largest economies are
    private corporations 47 are countries
  • GM is larger than Denmark and Turkey
  • Wal-Mart is larger than Israel and Greece

85
Corporations
  • 90 of transnational corporations headquartered
    in Northern Hemisphere
  • 500 companies control 70 of world trade
  • Corporations shouldered over 30 of the nations
    tax burden in 1950 vs. 8 today

86
Corporations
  • Purpose Make money for shareholders
  • Internalize profits
  • Externalize health and environmental costs

87
The Stock Market
  • The top 1 of Americans owns 51 of all stocks,
    bonds, and mutual fund assets
  • Consequences of Differential Stock Ownership
  • Corporations are answerable to their shareholders
  • Governments are answerable (at least in theory)
    to their citizens (either through elections or
    revolutions)

88
Corporations
  • Confidential legal settlements keep important
    public health and safety information secret
  • May delay governmental intervention, cause
    unnecessary morbidity and mortality
  • Corporate crime costs nation 35-150 times as much
    money as street crime

89
Corporate PR Tactics
  • Advertising
  • Greenwashing
  • Sponsored educational materials
  • Co-opting scientists and academic institutions

90
Corporate PR Tactics
  • Media control
  • Lobbying
  • Astroturfing - artificially-created grassroots
    coalitions
  • Corporate front groups

91
Corporate PR tactics
  • Invoke poor people as beneficiaries
  • Characterize opposition as technophobic,
    anti-science, and against progress
  • Portray their products as environmentally
    beneficial despite evidence to the contrary

92
Lobbying
  • Almost 15,000 full-time lobbyists
  • Estimates of return on lobbying range from 28 to
    100 for every 1 spent

93
Lobbying
  • Pharmaceutical lobby spent 1.3 billion on
    lobbying between 1998 and 2007 (more than any
    other industry)
  • 110 million in first half of 2010
  • 1,228 lobbyists (2.3 for every member of Congress)

94
Lobbying
  • Lobbying groups spent 3.5 billion in 2009
    (federal lobbying, a record)
  • All single issue ideological groups combined
    (e.g., pro-choice, anti-abortion, feminist and
    consumer organizations, senior citizens, etc.)
    spent well-under 100 million

95
Corporate-Sponsored Environmental Education
Materials
  • Exxons Energy Cube
  • -Gasoline is simply solar power hidden in
    decayed matter
  • -Offshore drilling creates reefs for fish
  • American Nuclear Societys Activities with the
    Atoms Family
  • Dows Chemipalooza

96
Advertising
  • US now spends 290 billion/yr on advertising
  • Almost 1,000/person/yr in the U.S.
  • 10 of a two-year olds nouns are brand names
  • The average American can recognize over 1,000
    corporate logos, but fewer than 10 plants and
    animals native to his/her locality

97
Corporations and Health
  • The insurance industry
  • The alliance between GE Medical Systems and
    NY-Presbyterian Hospital
  • Global Tobacco Treaty
  • The American Council on Science and Health
  • Prison-Industrial Complex

98
Pharmaceutical Industry
  • Influence over physicians through control of CME,
    gifts, research funding
  • Conduct seeding trials to alter prescribing
    patterns
  • Secrecy, statistical torturing of data sets,
    selective publication

99
Corporatization and Inequalities Threaten
Democracy
  • True democracy demands an informed citizenry
    (education), freedom of the press (media), and
    involvement (will, time, money)
  • Democracy is critical to public health

100
Ignorance vs. Democracy
  • Information is the currency of democracy
  • Thomas Jefferson

101
The Good News
  • Rebirth of public health
  • Political engagement of college freshman at
    all-time high
  • International Treaties
  • Montreal Protocol
  • REACH
  • Convention on Biological Diversitys draft
    protocol on biopiracy
  • But problems are urgent.

102
The Benefits of Sterility-Causing Chemicals in
the Workplace?
  • 12 September 1977
  • Dr. Eula Bingham, Assistant Secretary for
    Occupational Safety and Health Regarding
    worker exposure to DBCP. While involuntary
    sterility caused by a manufactured chemical may
    be bad, it is not necessarily so. After all,
    there are many people who are now paying to have
    themselves sterilized to assure they will no
    longer be able to become parents... If possible
    sterility is the main problem, couldnt workers
    who were old enough that they no longer wanted to
    have children accept such positions voluntarily?
    Orsome workers might volunteer for such
    workposts as an alternative to planned surgery
    for a vasectomy or tubal ligation, or as a means
    of getting around religious bans on birth
    control when they want no more children?
  • Sincerely,
  • Robert K. Phillips, National Peach Council

103
What you can do (Enjoy yourself)
  • Become active in an organization
  • Educate yourself/others
  • Use the media
  • Volunteer, do pro bono work
  • Satisfies your debt to society
  • Feeds your soul
  • Get politically active
  • Run for office

104
Power to the People, Not the Corporations
  • Support living wage laws
  • Restructure tax system
  • Combat corporate crime

105
Campaign for Fair and Representative Elections
  • Publicly financed campaigns and campaign finance
    reform
  • Proportional representation
  • Instant runoff voting/cumulative voting/range
    (rating) voting

106
Advocate for Womens Rights
  • Increase access to comprehensive reproductive
    health services
  • Combat domestic violence
  • Eliminate female genital cutting

107
SolutionsBased on the Precautionary Principle
  • When evidence points toward the potential of an
    activity to cause significant, widespread or
    irreparable harm to public health or the
    environment, options for avoiding that harm
    should be examined and pursued, even though the
    harm is not yet fully understood or proven

108
The Precautionary PrinciplePractical Essentials
  • Give human and environmental health the benefit
    of doubt
  • Include appropriate public participation in the
    discussion
  • Gather unbiased, scientific, technological and
    socioeconomic information
  • Consider less risky alternatives

109
The Precautionary Principle in Action
  • Montreal Protocol to phase out ozone-damaging
    chlorofluorocarbons
  • REACH (Registration, Evaluation and Authorization
    of Chemicals)

110
Save the Planet Together
  • Combat environmental degradation and global
    warming
  • E.g., reduce/reuse/recycle
  • Support local economies and fair trade policies
  • Encourage international cooperation

111
U.S. International Non-Cooperation/Isolationism
  • Failure to sign or approve
  • Kyoto Protocol on Climate Change
  • International Covenant on Economic, Social, and
    Cultural Rights
  • Convention on the Prohibition of Anti-Personnel
    Land Mines

112
U.S. International Non-Cooperation/Isolationism
  • Failure to sign or approve
  • Comprehensive Nuclear Test Ban Treaty
  • Convention on the Rights of the Child
  • Convention on the Elimination of Discrimination
    Against Women
  • Convention for the Suppression of Traffic in
    Persons

113
U.S. International Non-Cooperation/Isolationism
  • Failure to sign or approve
  • The Stockholm Convention on Persistent Organic
    Pollutants
  • The Basel Convention on the Control of
    Transboundary Movements of Hazardous Wastes
  • WHO International Code of Marketing of Breast
    Milk Substitutes

114
Promote Fairness and Prevention
  • Fight for more equitable distribution of medical
    research funds and health care dollars
  • Focus on prevention
  • 40 of US mortality due to tobacco, poor diet,
    physical inactivity, and misuse of alcohol
  • Every 1 invested in community-based programs to
    increase physical activity, improve nutrition,
    and prevent tobacco use saves 5.60 in health
    care costs

115
Work Together
  • Never doubt that a small group of thoughtful,
    committed people can change the world. Indeed, it
    is the only thing that ever has.
  • - Margaret Mead

116
Contemporary Activist Organizations
  • Physicians for Social Responsibility, Physicians
    for Human Rights, Amnesty International
  • Union of Concerned Scientists, Public Citizens
    Health Research Group
  • PNHP, Doctors without Borders, Doctors for Global
    Health
  • Greenpeace, Sierra Club, HCWH, NRDC, ED, No Dirty
    Gold, PANNA
  • Planned Parenthood, NARAL
  • Others

117
Speak Up for the Disenfranchised
  • The first job of a citizen is to keep your mouth
    open.
  • - Günter Grass

118
First they came for the Jewsby Pastor Niemoller
  • First they came for the Jews, and I did not
    speak up, for I was not a Jew.
  • Then they came for the communists, and I did not
    speak up for I was not a communist.
  • Then they came for the trade unionists, and I did
    not speak up, for I was not a trade unionist.
  • Then they came for me, and there was no one left
    to speak up for me.

119
Anita Roddick
  • "If you think you are too small to have an
    impact, try going to bed with a mosquito in your
    tent"

120
Contact Information
  • Public Health and Social Justice Website
  • http//www.publichealthandsocialjustice.org
  • http//www.phsj.org
  • martindonohoe_at_phsj.org
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