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“Hunger is a Social Construct”

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?

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Advertising for Childhood Obesity

The federal government is taking a stand against childhood obesity, asking the food industry to change the way that it advertises unhealthy foods to children.  The ultimatum is basically change your food or stop targeting kids.  With cereal boxes covered in colorful cartoon characters and junk food companies offering entertaining online games, it is not hard to understand why children are drawn to these products.  However, the issue is becoming serious enough that the use of characters like Toucan Sam to sell products is being equated to the issue of Joe Camel, a cartoon used to advertise Camel cigarettes years ago before it was outlawed due to its appeal to children.  Will these companies be willing to make the changes?

This attack on the food industry is an attempt to change the marketing structure so that children are not being enticed into obesity.  Not surprisingly, many of the food companies responded negatively to the proposal.  They claim that they have already made several changes in their recipes, such as reducing sugar and using more whole grains, to create healthier products.  Kellogg, while they reported they would look into the proposal, was one of the company’s that claimed to have improved their recipe.

I looked at the label for Froot Loops, a cereal sold by Kellogg, and the first ingredient listed is sugar, not the healthiest start to the day.  To add support to the argument against them, there is also partially hydrogenated vegetable oil in the cereal.  This is a trans fat (aka the worst kind of fat) that not only increases levels of LDL (bad cholesterol) but also lowers levels of HDL (good cholesterol), which actually help protect against heart disease.  Over time, consumption of trans fats clogs arteries and increases susceptibility to developing heart disease.  Why should we risk the health of children and ourselves by not only consuming these products but also for allowing them to target younger populations?

The proposal presented to the food industry creates nutrition guidelines for companies advertising to children: 1) The product must contain certain healthful ingredients such as fruit, vegetables, or low-fat milk and 2) The product cannot contain unhealthful amounts of sugar, salt, saturated fat, and trans fat.  Sugar, for example, would be limited to 8 grams per serving, far less than the 12 grams that are in one serving of Froot Loops.  While companies like Kellogg have apparently made some changes to their formulas, it is necessary for the health of the consumer to continue creating a healthier product.

On a more positive note: When I recently stopped at a Wal-Mart to pick up a snack for my drive home, I grabbed mini bags of baby carrots.  I was surprised and excited to see advertisement for the new movie Hop on the bags of carrots! They were attempting to appeal to  children, sending out the message that carrots are an appealing and nutritious alternative to unhealthy junk foods.  This company was taking the tactics of companies like McDonald’s and Kellogg to promote healthy eating.  Cartoon characters sell products, so why not utilize this to sell healthy foods too?

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A Half-Hearted Smoking Ban

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?

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Stillbirths – An Overlooked Statistic

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.

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Female Genital Cutting: How Should Public Health Respond?

Last semester for my Honors Introduction to Global Health project, I put together a presentation on the very serious issue of Female Gentital Cutting (FGC), also known as female circumcision or female genital mutilation (FGM). FGC involves a number of procedures, all of which involve the removal or refiguring of outer female genitalia. All of the associated procedures also lead to a number of very serious health conditions for girls and women, including excessive bleeding, any number of infections, and often fatal complications during childbirth. Many of the reasons for the perpetuation of this practice involve the very rigid gender expectations surrounding cleanliness, beauty, and sex.

FGC is still practiced in dozens of countries, including some in Asia, the Middle East, and Africa. Despite its global prevalence and the over one hundred millions girls currently living with the effects of this practice, many people in Western nations know little about the practice, including health care professionals. This is beginning to change, however, as this article in the New York Times notes. Increased immigration to the United States as also increased the number of girls and women living in the U.S. who have undergone this practice. Many young girls are even sent to their nation of origin to have the procedure done, often without their prior knowledge or consent.

This is certainly an issue that public health must be aware of and active in addressing. Addressing gender inequities is certainly one approach to eliminating this practice. However, addressing this practice in a culturally competent way is a major challenge. For instance, what are the implications of using the word “cutting” as opposed to “mutilation?” As the article notes, many girls and women avoid seeing health care professionals or talking to their physicians about undergoing this procedure because U.S. health professionals have little to no experience with this issue. Further, these women feel that they will be judged as “backward” or “uncivilized” if others find out about having the procedure done.

This practice is illegal in the United States, and there is a push to also make sending girls abroad to have it done also a crime. However, there is concern that this will only drive the practice underground, which will only magnify the negative health effects as women will either choose or not be allowed to seek medical attention in order to protect family members. Others are arguing for a harm reduction approach that medicalizes the procedure, especially in areas where the practice is common place. Currently, the practice is not usually done by someone with any medical training, in very unsanitary conditions, with a very unclean instrument. The argument is that by medicalizing it, and allowing it to be done under the care of a health care professional, the health effects can be minimized, saving a lot of pain and many lives. But would this legitimize the practice? Or would it be another step along the way to eliminating the practice? There are no easy answers to these questions, but they are questions that need to be explored both globally and in the United States.

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Overcoming “Apathy”

By: Matt Ryan

In a recent video I viewed on Ted.com, the author, Dave Meslin, makes a very simply and convincing argument for combating apathy. In this course, we are often faced with the harsh reality that many, if not most, people are simply disengaged with the inequities in our society. I think we find ourselves becoming frustrated with “the way things are,” but we seem rather hopeless and helpless in our pursuits to make real change. These are fair emotions, but they are not productive in reaching greater plateaus for our society. With that, this video argues that apathy is not how we view it. I think we often believe people simply do not care, but Meslin, and I tend to agree, argues that we do not set people up to care about important issues. This lesson is very important if we wish to change people’s mind and create collective action on issues.

The most memorable issue Meslin addresses is a situation in his hometown, Toronto. In the city magazine, there are different articles on restaurants, art fairs, and other cultural events. In these articles, there is always information regarding how one can visit or take part in the festival, or eat at the restaurant. In the political commentary, which addressed a sustainable issue important to Toronto’s operations, there is no information on how one can become involved. I think we would view this throughout society. We assume apathy out of people, so we do not take the basic steps to guide people to take action. To me, this is a social justice issue, or at least an important lesson to enacting social justice. If we expect people to address important issues, and to care about the world around them, we have to cultivate an environment in which people can easily feel empowered. Presently, we do not do this.

I think this issue can touch home here at SLU’s campus. Relating to how political events are promoted in Toronto is rather difficult, but Meslin’s message carries weight right here. I think if we really want to create a better world, our biggest challenge is to improve the community around us. Do we, at Saint Louis University, allow students to take part in our activities? Do we make them feel empowered in their student government elections? Do we promote events and engage students so that they will show up and possibly learn something? Or, do we catch ourselves assuming “nobody cares”, so we only cater to a few people. I find myself falling in this trap all the time. I find myself assuming people will not rally behind certain initiatives, so I do not take the steps to enact them. I think we need to view this differently.

People are not inherently apathetic. People care about issues that matter to them. The question is how do you make this clear. How do you engage people? Meslin’s video provides some inspiration. As agents of social justice, we need to be careful to fall in the trap where we just talk about things, but we do not actually engage others. Social justice is not a clique. It takes community action. This is the challenge, and the beauty, of public health.

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More technology brings more cancer

This article from the New York Times discusses the possible threat of thyroid cancer.  The topic gained a lot of concern after being addressed on the Dr. Oz show.  Dr. Oz said that thyroid cancer was “the fastest-growing cancer in women,” due to radiation from tooth x-rays and mammograms.  You can imagine how many women would become concerned about this health threat.

This is an example of how our technology and media contributes to how we view health.  Thyroid cancer has always been a health concern, but once it was discussed on national TV, people’s worries increases exponentially.  When a doctor on TV tells you that you are at an increased risk for cancer, you can’t help but get worried.  Especially since the increased health risk seems to be a direct cause of x-rays and mammograms–actions that can be very beneficial to a person’s health. Concern over radiation from Japan only contributes to these concerns.

When people’s health is threatened they panic.  However, the article also talks about how developments in technology might play a role in the number of people who are being diagnosed with thyroid cancer.  Though Dr. Oz called it “the fastest-growing cancer in women,” the increased prevalence is found in women of all ages.  If mammograms were a significant contributor to this issue, there would be an increase in women over 50 years old who were developing thyroid cancer.  The increase in the number of thyroid cancer cases has been attributed to the development of technology.  Nowadays, we are able to diagnose cancers that would not have been a significant health problem.

It is important to be informed about health, but it is also important to understand the true health threats.  Though radiation from a mammogram or tooth x-ray might increase the level of radiation in your body, that mammogram could save you from a worse health outcome.

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