By: Anita Cheng
When I heard Dr. Banerjee make this statement in an NPR interview for his new book Poor Economics: A Radical Rethinking of the Way to Fight Global Poverty, I was slightly taken aback. Certainly, I have heard race and gender described as social constructs, but hunger as well? Isn’t hunger a physiological manifestation from the lack of food? In the book, Dr. Banerjee examines how aid programs are not actually serving the needs of the poor. The majority of television advertisements requesting for viewers’ donations display emaciated individuals of the third world seeking nutrition. Dr. Banerjee shatters this age-old conception that the highest priority of the world’s poor is food. He argues that the poor are willing to make tradeoffs such as giving up some food in order to buy a television, just as the rich would. While survival is essential, finding ways to improve one’s life is just as important for this large demographic of the world. Dr. Banerjee raised the example that if you give a poor child some extra change, he or she would most likely purchase sweets instead of rice or bread.
Although Dr. Banerjee’s argument can be perceived as too radical or over-exaggerating the power the poor possesses to make these personal choices, it actually makes sense if one uses the lens of liberation theology to analyze the issue. During one of the last weeks of class, the topic of social and personal responsibility to health. One of the takeaway points was the importance of giving up some of our power as educated public health practitioners and acknowledge that the marginalized communities for whom we fight may actually hold the key to the solutions we are seeking to solve the problems they face. Liberation theology hones in on this point by underscoring how essential it is to be in solidarity with, engage in, and truly listen to the communities we are trying to empower.
Dr. Banerjee suggests a completely new way to infuse the diets of poor children with the nutrients they need – by investing in micronutrient-rich candy that is cheap and widely available (especially in schools). His method not only gauges the needs of the community but also maximizes benefits to the community by embracing instead of rejecting the behavior and personal choices made by the community. With Dr. Banerjee’s new methodology on helping the poor obtain what they need, is it possible to use the same framework in this country where the obesity epidemic is a much greater concern than malnutrition? Are there any behaviors of the obese population that we can embrace instead of reject?
By: Anita Cheng
Having traveled to China before, I was excited to see the BBC article titled “China ban on smoking in public places comes into force”. While my trip to Beijing in 2008 was filled with amazing historical sights and sounds of my native culture, it was also permeated by clouds of second hand smoke. Looking forward to another trip to the city this summer, I was relieved to see that I may no longer need to hold my breath in restaurants, railway stations, and other public venues. Further examination of the article brought about disappointing news, however. In fact, this smoking ban can be more accurately labeled as “recommendation” because there are no punishments if anyone or any business violates or ignores this rule. In offices, “employers will be obliged to warn staff of the dangers of smoking but not forbid them from lighting up at their desks”.
Using the Catholic Social Teaching framework, I can argue that an injustice is being committed against non-smokers who are being subjected to second-hand smoke. Catholic Social Teaching describes the state’s main role as protection of the rights of its people. If a right to health as a dimension of well-being is recognized, then the Chinese government has not fulfilled its role. Upon initial examination, I was confused as to the motivation behind this ban because the government was not planning on actually enforcing it. Further investigation revealed a possible answer to my query and a deeper injustice.
First of all, the article reported that the majority of China’s population is actually unaware of the toxins contained in cigarettes and second-hand smoke. My reaction was criticism of the government’s public health department’s inability to educate its people on this information. With the article’s disclosure that all of the tobacco products produced and sold in China were through state-owned firms and that sales are a generous source of revenue for the government, I could infer an explanation to my previous questions and criticisms. Catholic Social Teaching instructs that “free market forces must be tempered by moral considerations”. In addition to failure in protecting the right to health for its people, the Chinese government is profiting at the expense of its people’s – both smokers and nonsmokers – health. These actions are deemed social injustices with analysis through the Catholic Social Teaching lens. While identification of the problem is vital to the process of justice, an even more urgent question that must be answered is how public health practitioners should respond. With the country’s highest authority as the main culprit, how can institutional change be effectively implemented?
By: Anita Cheng
The Lancet recently released a collection of papers regarding stillbirths as an often overlooked statistic. According to this article, a stillbirth is defined as a baby born without signs of life after 28 weeks of gestation. This article highlights how stillbirths are often not counted in developing countries. The absence of this statistic prevents any goals or commitments from being established to prevent stillbirths. An interesting finding is that the causes of stillbirth are almost identical to those of maternal or neonatal deaths. Some examples include labor complications, maternal infections, high blood pressure, and diabetes. Similarly, preventing stillbirths involve better emergency obstetric care, folic acid supplements, malaria prevention, and improved detection and management of syphilis during pregnancy.
With the enormous focus on child health and maternal health in the Millennium Development Goals, I am surprised that stillbirths have been neglected. What is even more surprising is how, like maternal deaths, it is almost completely preventable, regardless of the development status of a country. While reading this article, I began thinking about the effects a stillbirth has on the mental health of a mother. The quote: “The grief of a stillborn is unlike any other form of grief: the months of excitement and expectation, planning, eager questions and the drama of labor — all magnifying the devastating incomprehension of giving birth to a baby bearing no signs of life” struck me deeply. Having previously done research on scarce mental health care resources not only in well-developed countries like the United States but also under-developed countries, in which the majority of stillbirths in the world occurs, I am concerned about the mental health of these mothers. While mothers in wealthier nations are able to seek out and afford mental health care to deal with the grieving process of a stillbirth, mothers in under-developed nations do not have this privilege and may be disproportionately at greater risk for psychiatric consequences associated with this type of pregnancy loss. Examples of these psychiatric consequences include depression and anxiety.
This report exemplifies how injustices beget injustices. In the first place, mental health disabilities carry an enormous stigma from First world to Third world cultures. Aside from being impacted by systematic disadvantages that prevent these mothers in under-developed nations from receiving proper pre-natal care, they are barred from proper mental health care after the traumatic experience of stillbirth. The loss of a child is an emotionally jarring experience and if this immense grief is not dealt with, poor mental health can lead to physical health consequences. Not only must public health practitioners work on providing prenatal and maternal care for all mothers but also address the dire need for appropriate psychological health care.
By: Anita Cheng
The recent political uprisings in the Middle East and Northern Africa have captured the attention of the global community. Speaking for myself, I have not considered how political turmoil has affected access to health care for civilians caught in the middle of often dangerous war zones. This article in the New York Times caught my attention. The Salmaniya Medical Complex, Bahrain’s largest public hospital, is now not only being guarded by government military forces but is virtually empty of health professionals and patients. This anomaly can be explained by the fact that the Sunni-majority Bahrain Government believes that this medical facility (staffed by mainly Shiite physicians) is being used as a hub for radical Shiite conspirators. Since the initiation of the conflict, medical professionals have been stopped from treating wounded individuals who have participated in opposition activities and those who allegedly disobey this command are arrested. The current health minister defends her position by stating that doctors have been purposely depriving patients of medical care or worsening patients’ wounds then subsequently asking news media to report of these cases to prove the government’s oppression of its people.
This situation in Bahrain is a social injustice on multiple levels. Because of these terrorizing incidents, local civilians are afraid to seek care at Salmaniya. In addition, since this medical facility is one of the largest in the area, this crackdown cuts off access to emergency care, blood bank, and drugs from its patients. Physicians and other medical care providers working in Salmaniya are forced to make a crucial decision in a “lose-lose” situation – Should they stop providing care to wounded demonstrators and protect themselves or should they defy the commands of its monarchy government and risk their personal security to save those who are participating in these uprisings? Whether the health minister’s claim is correct or not, one can argue that the motivation behind these physicians is to reveal atrocious human rights violation its government has committed against its people to the world. In addition, one can point out that the government’s “plan” to prevent these doctors from doing what they are allegedly doing is counterproductive because cutting off healthcare access is a human rights violation itself and is now being revealed by this article and perhaps other news outlets as well.
Describing this situation as “tricky” or “complex” is a great understatement. Since social justice is at the core of public health, what is the “just” action that should be taken to ensure that the right to healthcare and a safe work environment is reinstated for the people of Bahrain and its physicians and health care workers? Whose responsibility is it to put an end to these human rights violations? Would political and economic sanctions even work? If the allegations are indeed true that security forces have gone as far as stealing medical records to hide evidence of these violations, how can prosecutions against the Bahraini government be made without proof? If a solution to this crisis requires the resolution of the political conflicts, how long would the people of Bahrain have to wait before they can feel safe to see their doctors?
By: Anita Cheng
The rampant debates on Capitol Hill regarding the federal budget have captured every major headline in recent weeks. Among the proposed cuts is the elimination of the Title X Family Planning Program “Title Ten”. Prior to reading this article, I had no idea of the existence of this program under the Public Health Service Act signed by President Nixon in 1970. Through Title Ten, low-income and uninsured individuals gain access to not only contraceptives and family planning advice but also Pap tests for cervical cancer screenings, clinical breast exams, and tests for sexually transmitted diseases. Health care professionals working at clinics that are grantees of Title Ten stated that this program serves as an entry way for them to gain understanding of patients’ other health care needs that would otherwise go undetected. For example, individuals who enter the clinic in search of birth control pills may exit with new knowledge on how to reduce and maintain their high blood pressures or blood sugar levels.
One of the major reasons cited by supporters of eliminating funding for Title Ten is the program’s close ties to abortion services provided by Planned Parenthood. Twenty-five percent of Title Ten’s funding is funneled to Planned Parenthood, which provides abortion services through private money. However, every federal dollar replaces a private dollar that can fund programs that support abortions. Although I do not wish to comment on my personal beliefs surrounding the ethical complications of abortion, I agree with Dr. Hathaway’s statement on the injustice that is barring low income women from preventing pregnancy when resources are available in a country that possesses the most advanced medical technology. The elimination of Title Ten would only increase the abortion rate. Donovan’s comment in the article suggests the use of private insurance instead of federal funding to cover these services. This proposal, however, would perpetuate the problem we see in our healthcare system – that those who need care the most (the poor and uninsured) are the least likely to receive it.
In the current state of the economy, it is undeniable that budget cuts are necessary to prevent our federal budget deficit from falling deeper. However, where should the line be drawn when it comes to cutting programs that will result in propagating a pattern of social injustice? Do public health practitioners have enough political clout to warn lawmakers of consequences that will impact the health of their constituencies?
By: Anita Cheng
For those of us who have taken Introduction to Global Health, we have learned that one of the Millennium Development Goals is to improve maternal mortality. India adopted this goal as one of its major health priority and implemented free maternal health care for poor women as well as cash incentives for those who choose to deliver at a health facility rather than at home. From the perspective of a public health practitioner, these initiatives should theoretically reap better health outcomes for these pregnant women. However, a follow-up carried out by the Human Rights Watch in 2009 on the progress of these programs revealed contradicting results. In fact, no conclusive result on the efficacy of India’s maternal health initiatives can be gathered because of a lack of health records and poor health monitoring. Important questions such as exactly how many women die each year and how many women are benefiting from these programs cannot be answered with reliable figures.
A recent article in BBC reported the suspension of three senior doctors in the state of Rajasthan in connection to the deaths of eighteen pregnant women. Their cause of death was traced back to severe hemorrhaging after tainted intravenous fluids purchased by these physicians were administered. This horrific incident demonstrates yet another barrier to successful implementation of public health programs – corruption. In the second week of class, defining characteristics of community were discussed; among them, the class reached a consensus that a sense of trust between healthcare providers and patients is vital to preserving the quality of healthcare administered. Here, this sense of trust is betrayed, breaking the bonds of community. Moreover because physicians are among the most highly respected individuals in a community in the Indian culture, this blatant act of deception could generate a sense of distrust and absolute disappointment between patients in this community and their physicians. This mentality can generate repercussions such as a decrease in utilization of medical services in an already broken healthcare system. In addition, the public health initiative of distributing cash incentives to pregnant women who opt to give birth at a health facility instead of at home can completely backfire. It is evident that the negative consequences of this incident extend far beyond the victims and their families.
One of the defining characteristics of public health is its interdisciplinary nature. This situation questions how public health practitioners can address the issue of corruption among health care providers that plagues not only India but other developing countries as well. The answer lies not only in the field of public health but also requires collaboration with public policy and law enforcement. This tragedy proves that seemingly adequate public health initiatives can result in unforeseeable adverse consequences.
By: Anita Cheng
Sickle cell anemia is probably one of the most commonly studied genetic diseases in all biology courses. Individuals with this disease have an abnormal type of hemoglobin that causes red blood cells to adopt a crescent shape rather than the normal donut shape. Because of this abnormality, these cells have difficulty traversing through the circulatory system and subsequently damage vasculature (painfully) in the body. Although sickle cell anemia is an autosomal recessive disorder and takes two abnormal genes to manifest into the physical disease, it occurs in about one in five hundred African American births because the sickle cell trait occurs in one in twelve African Americans. Treatment for sickle cell anemia include antibiotics for newborns to prevent infection, education for parents on how to manage the disease, over-the-counter pain relievers, eye checkups, regular physical checkups with a primary care physician, blood transfusion, and possibly gene therapy. While it has already been established that natural lottery determines who gets sickle cell anemia, the social lottery determines who gets quality treatment. It merits our attention that the prevalence of this disease is so high among African Americans.
The writing prompt for last week’s readings asked whether we should respond differently to a disease based on whether it was caused by action of personal choice rather than natural or social lottery. Because our discussion surrounded the impact of (poor) personal choice on health, I wanted to draw attention to the natural and social lotteries of health outcomes. While I rarely pondered on the relationship between management of genetic diseases and poor socioeconomic status, this article challenged me to do so with sickle cell anemia. Despite the fact that there is no absolute cure for sickle cell anemia, technological advances in medicine has made it easier to manage this disease – if you have the right resources. This is where the social lottery comes in. Take Davina Daniels, an African American single mother from Queens who is the subject of the article. Since her exact socioeconomic status is not disclosed, let us picture her living in North St. Louis City with two small children. How will her access to quality treatment be affected? Even if she has Medicaid, which does cover treatment for sickle cell anemia, what if she cannot afford to take off work early for regular checkups with her physician because it takes two hours to travel to the hospital by public transportation? What if she cannot find anyone to take care of her children during her doctor visits? What if she cannot afford over-the-counter pain relievers and she must give up a few days of wages because the pain is too unbearable? What if Daniels dropped out of high school and has limited health literacy skills? How does that affect her ability to understand her condition and how to manage it well?
As public health students, how do we respond to the detrimental effects the natural and social lotteries impose upon sickle cell anemia patients? Even if we cannot change the genetic makeup of the entire African American population to decrease the chance of children born with sickle cell anemia, methods to equalize the opportunity for all to sustain a sense of well-being, with sickle cell anemia or not, exist. To further challenge the reader and connect this topic with the upcoming week’s discussion, how do the three levels of racism further complicate the issue?