Public Health

This commentary appeared on the Asia Healthcare Blog on May 10, 2013.

Chinese health officials announced recently that a new bird flu virus is bringing sickness and death to dozens of seemingly random victims in the eastern part of the country. Scientists have classified this new flu as subtype H7N9.

Like its cousin H5N1, this latest version of the avian flu virus successfully made the jump from birds to people. And like its predecessor it is especially deadly, according to the leader of an international investigation team from the World Health Organization (WHO). Authorities aren't certain how all its victims have been infected, but they have found no evidence, for now at least, that ongoing spread from person to person is occurring.

In Sub-Saharan Africa, illness and death from malaria remain harsh realities. While the psychological and social consequences are keenly felt by those living in countries where the malady is most endemic, the economic implications are less well understood.

Our ongoing work on malaria shows that tackling the illness in this region will not only have positive effects for the economy as a whole, but possibly also a redistributive effect—slowing down the rising income inequality in Sub-Saharan Africa. As people across the globe mark World Malaria Day 2013 on April 25, the economics of the disease should be part of the discussion.

Spending money on malaria reduction is, from an economic perspective, a long-term investment. Whilst the effects of increasing the use of bed nets or other preventative interventions on public health are immediately visible, it will take decades before we can observe a visible impact on the economy.

This commentary appeared on CNN on April 18, 2013.

A pair of deadly bomb blasts marked a violent and tragic finish to this year's Boston Marathon. But as shocking as the attack may have been, an act like this has been anticipated for some time. It was a surprise, because none of us awoke the morning of the Marathon anticipating the race would end this way. Yet a terrorist attack against a symbolic target or a heavily attended event was something for which authorities had long prepared.

Authorities have known for some time that a wide range of terrorist organizations, extremist groups and individuals — both foreign and domestic — seek to inflict harm on the United States. And this knowledge motivated federal, state and local agencies to devise protocols to enhance their response to mass casualty events. Although official after-action reports are still being compiled, it looks like Boston's first responders and hospitals delivered under difficult circumstances....

The remainder of this op-ed can be found at cnn.com.

This commentary appeared in New York Daily News on March 25, 2013.

According to a poll released this month by the Pew Research Center, nearly half of American gun owners report that their main reason for having a gun is protection; fewer than a third own a gun primarily for hunting. This is a striking change from 1999, when nearly half of gun owners kept firearms mainly for hunting and only about one quarter cited protection as their most important reason.

Pew's results might make sense if violent crime were surging. But it's not. Since 1993, homicide and non-negligent manslaughter in the U.S. have been cut in half. Violent crime overall is down 48%. But perhaps even more important — and less understood — an ample body of evidence indicates that the benefits of keeping a gun for protection are substantially outweighed by the associated risks.

If a medical treatment worked only a fraction of the time and resulted in bad outcomes more often than not, practitioners would not make this treatment the default approach. Yet that is exactly what has happened when it comes to CPR for individuals 85 years and older who suffer cardiac arrest in a community setting.

In a recent op-ed in the Los Angeles Times, Kevin M. Dirksen and RAND's Neil S. Wenger explain that, like heart surgeries and joint replacements, CPR should only be performed on elderly patients when and where it is appropriate.

Public health practitioners most often work behind the scenes to keep bad things from happening. They conduct inspections to ensure that restaurants are safe places for people to eat. They provide immunizations to prevent people from getting diseases. They help ensure safe water and sanitation. They educate people about healthy lifestyle choices regarding diet and exercise. They collect and analyze surveillance data to detect and monitor potential health problems.

But bad things do happen, and when they do, public health practitioners are also there. Disasters, including Superstorm Sandy on the Atlantic coast; tornadoes in Alabama and Missouri; earthquakes in Haiti, New Zealand, Chile, and northern Japan; the 2009 H1N1 influenza pandemic; and the post-9/11 anthrax attacks have taught us that public health is not just about prevention. It is also about preparedness, response, and recovery. Public health practitioners are the front line force for national health security, ensuring that communities are prepared for, protected from, and resilient in the face of, a full range of health threats or incidents with potentially negative health consequences.

On January 31, RAND published a paper in Environmental Research Letters estimating the total monetary costs—often referred to as “damages” in environmental health and regulatory considerations—caused by air pollution emissions from shale gas extraction in Pennsylvania. This process of removing natural gas from shale is popularly referred to as “fracking.”

The RAND study estimated these damages from conventional air emissions from extraction activities to range between $7.2 and $32 million dollars. This is small compared to the $75 million in estimated annual damages produced by the state's single largest coal-fired power plant in 2008. In both estimates, the bulk of the damages were related to health impacts—such as increased incidences of asthma, hospitalization, and premature death that can result from breathing these pollutants—but it also accounts for damages to agriculture and infrastructure. This analysis looked only at the effects of air, not water, pollution.

This commentary appeared on The Huffington Post on February 1, 2013.

The Super Bowl is the promised land for advertising agencies. More than 100 million engaged consumers, even those otherwise uninterested in football, will turn on their TVs Sunday night and watch the commercials and halftime extravaganza.

This year, Beyoncé Knowles-Carter will headline the halftime show as part of a $50 million contract with PepsiCo's Live for Now Campaign. The campaign's most prominent image—scheduled to appear life-size in stores this year—Beyoncé in a scant Pepsi-blue outfit, pushing a shopping cart filled with 12-packs of full-calorie Pepsi. While the public health community was outraged by Beyoncé's deal with Pepsi, American consumers didn't seem to mind. In fact, so many celebrities have done similar endorsements that, as the Atlantic's health editor notes, it would take "a lot of cultural unwinding" for soda endorsements to be frowned upon by the general public.

RAND congratulates senior policy researcher Lois Davis, whose work on the public health consequences of prisoner re-entry in California earned RAND the 64th Assembly District's “AB 109 Re-Entry Award.” The award was presented to Davis by Assemblyman Isadore Hall III of the 64th District, Chair of the Assembly's Governmental Organization Committee. In a letter to RAND President and CEO Michael Rich, Assemblyman Hall cited RAND's “outstanding contributions and unwavering dedication to our community” through Davis's work on the public health consequences of prisoner re-entry in the state.

This fall, advertisements for flu shots in U.S. drug stores have been competing for attention with Halloween, Thanksgiving, and, now, Christmas displays. Unfortunately, if this season's statistics follow those of previous years, these ads will fail to rally shoppers to action more often than not. What's needed, according to RAND research, is more proactive engagement by doctors and medical staff.

First a bit of background. Despite the convenience of "retail clinics" and the flu's astounding financial costs ($87 billion, according to a 2007 Lancet study), vaccination rates for influenza among adults have remained flat over the past two years at under 40%. Even during the 2009 H1N1 pandemic, more than half of all health care workers declined vaccinations, putting both themselves and their medically vulnerable patients at risk for transmission.