Paul Statt Communications

Why would we risk a human life because of of our stereotyped images of the drug addict or welfare queen?

“The idea that the welfare rolls are filled with people who are dependent on illicit drugs, there’s no evidence to support that that I know of,” said Harold Pollack, a University of Chicago professor who has spent years studying the topic. “It concerns me that it feeds into a very stigmatizing set of stereotypes and expectations about welfare recipients that can be quite harmful.”

That’s what Emily Badger reported in Miller-McCune February 25. I can’t remember a time when the evidence from the research so clearly contradicted a congressman’s–Orrin Hatch’s–argument for changing a law that could affect public health.

“This amendment is a way to help people get off of drugs to become productive and healthy members of society, while ensuring that valuable taxpayer dollars aren’t wasted,” the Utah Republican said at the time. His two-pronged argument, since repeated by others, suggests public assistance is “wasted” on drug abusers, even as public assistance programs could be used to identify and help them.

Lost in the discussion–and a topic I would like to see researched–is the question of how many drug users do not seek treatment because they fear they might lose what meager benefits they now get.

Public transportation, like, say, public health or the public library, just isn’t sexy.

But a fat slob isn’t sexy, either, is he? And with public transportation, he could build a sexy new physique in only 6 to 8 months, according to a recent publication in the the American Journal of Preventive Medicine.  A journal that probably wouldn’t borrow the title I tore from the Cosmo stylebook, but the researchers’ clear conclusion is:

“The use of LRT [Light Rail Transit] to commute to work was associated with an average −1.18 reduction in BMI [Body Mass Index] (p<0.05) and an 81% reduced odds (95% CI=0.04, 0.92) of becoming obese over time.”

They used a “natural experiment” to check on people’s weight and physical activity before and after new light rail transit was built in 2007 in Charlotte, NC. People who rode light rail to work were 6.45 pounds lighter than commuters in cars. The authors realize that flaw of the study is that all the results were “self reported.” But the statistical analysis is solid.

You could click the link below, or saunter overt to the public library to read the full paper. If you’re in Charlotte, there’s public transport.

MacDonald JM, Stokes RJ, Cohen DA, Kofner A, & Ridgeway GK (2010). The effect of light rail transit on body mass index and physical activity. American journal of preventive medicine, 39 (2), 105-12 PMID: 20621257

Do higher taxes change behavior?

Generally speaking, yes. The laws of economics are pretty strict about this stuff: raise the price of booze, butts or junk food, and without even thinking about, we–that is, homo oeconomicus–cut back. But for public health law, the research question has to be: do we really get any healthier?

Alex C. Wagenaar, associate director of Public Health Law Research, just published a paper that found “significant reductions in mortality related to chronic heavy alcohol consumption following legislatively induced increases in alcohol taxes in Florida.” Raise alcohol taxes. Fewer drunks die.

This kind of research must be painstaking and methodical. Isn’t it odd: to support the obvious truth, you need to take special care. Wagenaar at al. needed data from 1969 through 2004, and “a time-series quasi-experimental research design…” “including nonalcohol deaths within Florida and other states’ rates of alcohol-related mortality for comparison. A total of 432 monthly observations of mortality in Florida were examined over the 36-year period. Analyses included ARIMA, fixed-effects, and random-effects models, including a noise model, tax independent variables, and structural covariates.”

It’s heavy. This is the kind of research that should be driving public policy,

Maldonado-Molina, M., & Wagenaar, A. (2010). Effects of Alcohol Taxes on Alcohol-Related Mortality in Florida: Time-Series Analyses From 1969 to 2004 Alcoholism: Clinical and Experimental Research DOI: 10.1111/j.1530-0277.2010.01280.x

In 97 Orchard: An Edible History of Five Immigrant Families in One New York Tenement ($25.99 New York, 2010) Jane Zieligman writes:

In the early 1920s a Boston dietitian named Bertha Wood conducted a multi-ethnic study of immigrant eating habits, eventually published as a book, Foods of the Foreign Born in Relation to Health. As the title suggests, the book was written for health-care professionals–visiting nurses, settlement workers, dispensary doctors–who served the immigrant community.

Wood’s “curious little book” in Zeiligman’s words, blames a single food for much of the difficulty Jewish immigrants faced: that “much-loved Jewish staple: the pickle.”

The briny garlicky sour cucumber was the gateway intoxicant for Jewish kids, according to Zeiligman: “The undernourished child was drawn to pickles the same way an adult was drawn to alcohol. More than a food, the pickle was a kind of drug for tenement children, who were still too young for whiskey.”

In Zeiligman’s mouthwatering tour of the kitchens of the Lower East Side, contemporary reformers saw many dangers lurking in the immigrants’ foodstuffs. To name only a few:

• Home candy manufacturing;
• The pushcart markets;
• Excessive consumption of greens;
• Highly seasoned foods.

The superannuated antics of old-time public health reformers are good for a laugh. But in the folk memory of many Americans, the Keystone Healthkare Kops are still at work, trying to “tell us what’s good for us.”

The difference between public health law then and now has to be research. If today’s reformers want to change the way Americans eat, they must be damned sure that there is solid empirical evidence that

• the proposed changes in diet are good for the public health, and,
• the proposed changes in laws and regulations will change the public’s behavior.

A recent paper does shows how to do that. “A Framework for Public Health Law Research,” defines this emerging scientific discipline and explores the promise and challenges of studying the impact of laws on health.

Public health experts, legal scholars and policy makers are increasingly recognizing that laws can keep people safe and healthy; for example, by encouraging the use of seat belts and by keeping the environment safe from toxins. This growing recognition has led to the emergence of “public health law research”, a developing field aimed at studying the intended and unintended consequences of laws on public health as a way to support evidence-based policy making.

Scott Burris, director of Public Health Law Research, a national program of the Robert Wood Johnson Foundation administered through Temple University, wrote the paper with Michelle Mello of the Harvard School of Public Health, Alexander Wagenaar of the University of Florida College of Medicine, Jeffery Swanson of Duke University School of Medicine, Jennifer Ibrahim of Temple University, and Jennifer Wood of Temple University.

BURRIS, S., WAGENAAR, A., SWANSON, J., IBRAHIM, J., WOOD, J., & MELLO, M. (2010). Making the Case for Laws That Improve Health: A Framework for Public Health Law Research Milbank Quarterly, 88 (2), 169-210 DOI: 10.1111/j.1468-0009.2010.00595.x

How can you measure the impact of a law? The Obama administration, for example, recently called for an “evidence-based” approach to the writing of laws and policies that affect the public’s health in matters of drug abuse. But applying the scientific method to an evaluation of a law’s impact requires a rigorous approach to measurement. In “Measuring Law for Public HealthEvaluation Research,” published in the June 2010 Evaluation Review, Charles Tremper, Sue Thomas and Alexander C. Wagenaar provide researchers good guidance for legal researchers.

The authors write that in order to measure effectively the effectiveness of a law, one must “focus on the “is” rather than the “ought” ” of the legal environment, taking such into account such variables such as enforcement policies, financial appropriations and even the simple question of law’s effective date. The suggestions and procedures offered in this paper will improve “the utility and accuracy of research that uses legal data, ultimately improving public policy and its effectiveness in achieving important goals in advancing population health and well-being,” the authors conclude. “By blending the knowledge and skills of social scientists with that of legal experts, scholars can produce more accurate and more useful policy evaluations.”

Tremper, C., Thomas, S., & Wagenaar, A. (2010). Measuring Law for Evaluation Research Evaluation Review, 34 (3), 242-266 DOI: 10.1177/0193841X10370018

There’s a legitimate argument against “crying wolf,” that is, frightening children with scary stories about what might happen to their health if they don’t wash their hands properly. Jeffrey Hall Dobken, M.D., a professor of pediatrics at Weill Cornell School of Medicine in New York and a N.J. bioethicist, makes the argument in MedPage Today: Columns – And Now a Word … – About Crying Wolf.

We live in a society of fear. “Terrorism” is its most visible manifestation, but “health” is also hard to miss. But rather than moving to either pole–fearing that anything might kill us, or ignoring all possible dangers–I wish that we could respond to solid mathematical and scientific evidence, and not to our reptilian instincts.

China instituted quarantines and strict immigration rules earlier this year, in response to the H1N1 virus. According to a front-page story in The New York Times (Nov. 12, 2009) “Chinese and foreign health officials say that some of those contested measures — more easily adopted by an authoritarian state — may have helped slow the spread of the disease in the world’s most populous country. ”

Unfortunately, no research is cited.

The best that reporter Edward Wong can offer as evidence: ““I think there were a variety of measures put in place by different countries, and it’s difficult to say what worked best and what didn’t, but China’s has worked very well,” said Dr. Michael O’Leary, the director of the Beijing office of the World Health Organization.”

I was struck by the deft analogy Shannon Brownlee and Jeanne Lenzer used to describe the experts who question the research behind the H1N1 vaccine.

” Like the engineers who warned for years about the levees of New Orleans, these experts caution that our defenses may be flawed, and quite possibly useless against a truly lethal flu. And that unless we are willing to ask fundamental questions about the science behind flu vaccines and antiviral drugs, we could find ourselves, in a bad epidemic, as helpless as the citizens of New Orleans during Hurricane Katrina.”

Granted. But no sane engineer looking at flood control before Katrina was arguing we should “tear down this levee.” That’s in effect what people opposed to flu vaccination are saying .