In a prior posting I talked about the quick fix culture that has evolved into our 'it's all about me' and 'want it now' way of living. Which brings up a continued question as to how this will affect our future generations. As someone working on a college campus, my job is to understand the health trends amongst our students and find ways to provide meaningful and effective programs and services to educate, empower and engage. The environment our youth grow up in is increasingly complex, high stakes and filled with a multitude of choices. As I focus specifically on alcohol prevention, I've found that the college experience has changed for our young people. A college degree today is a requirement and not necessarily an advantage, thus just going to any college doesn't guarantee a job. However, the transition to college life is still viewed as the time to let loose and experiment in social decision making. Students have increasing pressure to excel amidst an environment that is set up to guarantee success among a small sub set of the population; how will they be able to let loose while facing the pressure to be perfect?

A common way of existing that I've seen during my generation, was this idea of living a life you choose based on where you are or who you are with. Secularism has become a strong part of American society. Many catholics left the church, post holocaust Jews became more secular and a culture of sinning for 6 days and repenting for one day seemed to become more prevalent. Hyper sexuality, voyeurism and selfish indulgence have become a mainstay of self expression. This is evident in our culture of excess and the effect it is having on American's health. Could the mentality that we as inviduals are primarily accountable to ourselves- be a part of this? Is it really possible for an 18 year old to have complete responsibility over their choices in understanding their long term effects? No, and this may be why mental health problems of anxiety, depression and instability are emerging as a key health issue amongst our youth.



How might this change in the context of the hardships our society has gone through in recent years? Many young people graduating from college face the reality of not being able to get a job. This struggle has grown progressively over the last 5 years. When I graduated the challenge was about being able to translate an academic degree into a professional career. Today, many young people are going into public service. This might possibly help to build a more collective culture. The idea of community may soon become a necessity, given that we must band together to ensure our success. Questions as to whether the government is invested in our best interest hopefully become a part of daily conversations,  and may finally alleviate the apathy amongst Americans.

Yet, there's much work to do. For too long we have sufficed in leaving behind those below us and giving power to those above us. Young people endeavoring in opportunities to give back to communities they may have never stepped foot in can open this door. Americans are holding accountable those who held the power and ultimately manipulated the majority. Institutions are now being forced to restructure and find ways to appeal to and accomodate for most Americans in addition to fulfilling self interests. In this process we must continue to keep the fate of our young people in mind. This is something I constantly think about while walking within the walls of an institution, and I continue to push for our young people to be at the table. Our success depends on the future, however we cannot ensure this until we ask, listen and include. Take a minute to get to know the young people around you and you'll realize how much you have to learn.

In the past 20-30 years, along with a rise in the world's population and increased capacity in science and technology, we have been able to  further track, monitor and study the spread of human disease. These advances have allowed us to combat such epidemics as Malaria, Tuberculosis and HIV/AIDS. Yet, in recent years the human exchange of goods and services across continental borders has led to an increased susceptibility to zoonotic diseases, mutation of common viral strains and the onslaught of pandemic flu. Swine flu is on its way to becoming an epidemic and as we try to identify the scope of this public health problem, we look at the origins and causes of the disease and its spread.

I saw a report today on CNN where people in Mexico were being asked where the disease came from. Many were saying that it came from Canada or the US, and one man said that we (the US) are always finding a way to blame it on Mexico. He said something to the effect of "if there's a jalapeno in the US that causes a disease outbreak, then it must be from Mexico." This is I think where the disparity lies. While we worry about a flu epidemic, we forget that millions of people in developing countries die from preventable diseases like Malaria, acute respiratory infections and cholera. We fret over a struggling US economy while 75% of the world lives on less than a dollar a day. As a human society, we are paying the price for global exploitation of ourselves and our natural environment for the production of goods and services. Anyone could list off the many economic development principles that have been driving the ignorance and oversight that we are left to see the results of today. The reality is that in this transition, a generational shift that everyone will see at least once in their lifetime, we can easily lose sight of what brought us here.



During a disease outbreak it is important for public health officials to monitor transmission of the disease, implement strategies and controls for preventing its spread and tracking confirmed cases, treatments and associated deaths. This must be translated to the public in a way that provides enough information to understand the scope of the problem, to know how to protect ourselves, without insighting chaos or hysteria.

If you are worried about contracting the flu, remember that it is treatable, it is not life threatening and we are lucky to be in a country where your likelihood of experiencing severe consequences is minimal. However, it may also be important to consider what brought us here today. The idea that we should be helping poor countries and those suffering around the world is not one of pity. Before we feel sorry for ourselves or others, we should consider, how to take a stand, not right wrongs, but move forward towards sustainable solutions withouht forgetting what leads us to trail behind in the fight for progress.

In prior entries I've talked about the importance of ownership in the group process and the neccessity for accountability to the communities we serve. One political issue I've not yet delved into on this blog is the Israel Palestine conflict. I'd like to talk about this today and provide some commentary in a broader context. The three words entitled for this entry I think all apply to what is happening now and has happened with the peace process over the past nearly 61 years. There has been a fight for ownership in this region of the middle east, Who's responsible for shaking up this situation is constantly debated over along with who's accountable to do something about it and is that acceptable. This is where it becomes very complex. As I have in prior posts, I will start by stating my stance: I am Jewish, I strongly support Israel and the right to protect its border. Never will I condone or defend actions that violate human rights and I feel that this should not be ignored. This is what makes this issue complex for me.

There are many ways that we can rationalize behavior from the micro to macro levels. We can choose to take responsibility for some things and not for others. However, we must realize that if we do not take responsibility or we are remiss to acknowledge whether our actions have contributed to the pain or suffering of ourselves or others, we are limiting the way in which we can or will be accountable. In addition to this, the ability to accept the problem and find a solution becomes stifled. Yet, the key thing to understand is that all parties play a role in this type of approach to a problem and we must acknowledge the history and context that brought us to where we are.

                               
I often think about the conflict in Israel and the middle east and every time I do so there is a different way of looking at it. We need to ask: Why did Jews need to establish a state and what was the reason for Israel? Why can't the land be shared and how is it possible that it would have been taken away from Palestinians? What is contributing to the problems with violence and human rights today? Both countries need to ask these questions and answer them within the context of their own history, actions and philisophical view points. We must also ask who was involved in determining, supporting and condoning the ways in which these countries operate. Yet, this is such a complex issue and until we admit that we will never fully understand all of it, there will be no way of coming to consensus.

I'll conclude by providing a few specific examples in context with these questions. With the recent conference on racism in Geneva and an emphasis on Zionism within this event, many are focusing in on the claims associated with Israel being an opressor of the Palestinian people. However, let's remember that Zionism started before World War II and it only became an urgent call to action when the Jewish people were nearly destroyed. Additionally let's remember that throughout history, Jerusalem and the surrounding territory have been fought over which did not have distinct ownership or a ruling power until Israel was founded. Finally, we must recognize that Palestinians in Israel have much better outcomes for health and education than they do in Arab countries and Jews are treated much worse in these countries as well. The US and the middle east must take responsibility for and accountability to the role they play in this conflict, while reaching towards acceptance of a shared role in negotiating peace and prosperity. There's much more to this issue, of which I plan to write about. Share your thoughts and help me to model open dialogue.

Recent news of American journalist and former Ms. North Dakota Roxana Saberis' conviction in Iran and a report amongst others of murder suicide among a family in Maryland, leads to the ongoing question about capitalism and greed turning on its head. CNN's Don Lemmon on Saturday said the Saberis conviction was "another potential land mine in America's troubled relationship with Iran"
History has shown that in times of high stress, societies tend to act out through violence, especially when they feel as though there's no way out. The amazing amount of influence that the US economy has had on the world is now paying the price. Somalian pirates are holding US and other fleets hostage to earn money through ransoms, violence on the mexican border has exposed the corruption and greed associated with the US Mexican drug trade and now reports of increased violence over the past ten years from "going postal," columbine, Virgina tech and murder suicide are alarming trends that need to be addressed.

I see the source of many of these problems stemming from capitalism and greed promoting an unrealistic set of standards for income, appearance and overall worth in society. Individualist ideals truly exemplify the purest sense of survival of the fittest, however should we measure fitness by an inability to age and capability of making the most money all on our own? Should this be done at the stake of outsourcing jobs and corporations like the oil industry ruining Somali communities because their operating production facilities that would never be allowed nor tolerated in the US? These are unhealthy and non sustainable ways of living that although has increased lifespan greatly in developed countries, only so many individuals can actually reach these levels of expectation. In other words, we might be living longer, but does that mean we're happy, or most can really enjoy life?



Consequently, as I've discussed before, many Americans are finding artificial ways to appear healthy and productive. When suddenly the facade of success is swept out from under the rug or individuals feel hopeless, they act out in ways that are not usually considered normal. Many people in developing countries and underserved communities find the easiest way they know how to earn money or take care of themselves. Yet, it is the culture in our own community environments that may condone or discourage extreme behaviors and when we are promoting materialism as a sign of "social health" we are in many ways condoning unhealthy ways of living. Thus we are projecting this on to other communities when we take advantage of their resources and pass it off by saying that our government provides them with millions in foreign aid. The problem here is that there is a clear imbalance. We must address this and can not do so by only focusing on one side of the issue. Narrow focus relates to minute outcomes. As I always try to supplant, this is not impossible. We should look at why many are giving up and setting aside their morals and talk about ways that we can support each other and exercise the beautiful freedoms that we have on many levels in this country. There's more to be done and we can do it.

In a prior posting I talked about border control issues and the impracticality of building a wall along the US Mexico border, when currently only half of the border has an existing barrier. Recent problems, controversy and reports on violence and drug trafficking along the border as well as the continued debate on immigration has motivated me to comment  further on this subject.  As many well know, illegal immigration has been a heated political issue in recent years as the Latino population has continued to grow in the US and many have responded negatively to the increased presence of undocumented immigrants. These people have become a part of our communities, yet our history with Mexico goes back much further. As a result of the US Mexican war from 1846-1848, Mexico lost much of its territory along the current Southwest of the United States. Mexicans have continued to immigrate to the US since then and have deeps roots within our Nation's history.

Current tensions around illegal immigration relate to individuals utilizing government funded resources such as schools and accessing healthcare primarily through Emergency Room visits without paying taxes. To state plainly before I go further, I am against many of the policies towards illegal immigration that our government has implemented. I do not see Immigration and Customs Enforcement raids leading to arrest and deportation and increased enforcement along the border as effective and sustainable methods for immigration control. Given that there is a long history of Mexicans in the US, we would be fooling ourselves to think that these methods are fair or just. 



                                                                  

Recent surges in illegal immigration became opportunities for many in the labor sector to exploit these individuals for cheap labor. Yet, this is also a historical issue that goes back to farm workers in California and the civil rights movement against this type of exploitation led by Cesar Chavez. This makes me wonder whether a narrow interest in our economy and assuring all who live in this country contribute equally is actually pushing aside our history and ignoring the fact that in many ways our country has condoned illegal immigration. Commercial industries have capitalized on the Spanish speaking population here in the US by developing marketing materials and campaigns in Spanish and geared towards these populations. Our government and healthcare systems have made efforts to accomodate these populations among others, by providing information and services in their native language.

However, when this seems to become too much or too difficult, we just decide to  seek out all undocumented individuals and send them back to Mexico? Who would work in factories, on farms and the many other industries where a large number of undocumented folks are currently working? What happens to the children of undocumented immigrants who were born in the US and are legal citizens? These are questions we must continue to ask and I hope that the new administration will consider.

A practical solution is to give individuals who've been here for longer than 5 years a certain amount of time to gain permanent residency or citizenship. We can take certain measures to ensure that recent illegal immigrants, particularly those with a criminal record will face deportation. However, let's not discount the fact that Mexican and Latino culture and traditions are a large part of this nation's culture, history and richness that it exudes.

As a follow up to a prior posting on drug culture, I'd like to further comment on this issue in regards to preventing and controlling the its negative impacts. I recently saw a story this morning on CNN about a young girl who died from a heroin overdose, which was followed up by a commentary with a Harvard economist and former DEA agent about legalizing such drugs. This made me think about the lessons of my work, in that policy change alone will never address the societal issues which are contributing to the risky behavior of teens. As I've talked about before, similar behaviors exists among new trends in teen exploits such as sexting, prescription drug abuse and emerging trends of methamphetamine use amongst middle class teens and adults.

The economist in this segment was arguing that legalization of these drugs would allow for further regulation and restriction on drug trade and availability. His theory was that we spend millions of dollars on enforcing drug laws, and we've learned from prohibition that restricting drugs can in many cases worsen the problem. However, the DEA agent argued that drug use requires us to also spend exorbitant amounts of money on addiction treatment and increased accessibility will only make this worse.



                                                                    

My reaction to this was that neither approach will work, especially in isolation. De-criminalizing drug use and possession is an effective measure, however legalization and more of a focus on treatment will not be effective. These are tools to addressing problems associated with drug abuse, however the fact that these trends are emerging among teens reminds me of the collective responsibility we all have. We as a community must come together to support our teens who are often finding discrete ways to express or relieve their angst and thus if we only try to solve problems in isolation or with a narrow approach, we will never see change.

Just as many teens say "that won't happen to me" adults are doing the same. We've learned that restriction will not work and in many cases will entice teens to further experiment. What we must do though is create a supportive environment where young people feel that they can communicate openly and seek support for the challenges they face at this stage in their lives. In many ways it is the nature of teens to become more removed or less open with their parents and other adults, however we must not use this as an excuse to focus our attention elsewhere.

Our biggest challenge, and one that I constantly face while working in the field of prevention is that we need to be more proactive. Often with issues related to alcohol and drugs, communities don't respond until their is a tragedy. Then, the parents and community members who thought it would never happen to them, suddenly are motivated to act because it has hit close to home. Yet, will we respond and then when the commotion dies down we forget about it? This is where a comprehensive approach which includes, policy, resource development and capacity building comes in. However, this can never be done without the support of the collective. To do so, we must hold ourselves to the same standards in which many of us hold to our youth. Share in the journey to enjoy a better world, one that already exists, we just need to seek it out.

As I was reminded that it's national public health week I watched an interesting video on the website: http://www.publichealthgeneration.org This reminded me of the impact that this industry can have on the health of our community. Today I gave a presentation to the leadership team in my division along with one of my colleagues in the health center. I talked about my work on alcohol prevention and he talked about occupational health. As he began his presentation after me, Dr. Shelden reminded us of the prevention paradox. Our goals is to prevent problems, and when the problems don't exist we've done our job. Public health has come to the forefront in recent years and in many ways because of the growth and complexity of our world. As I've discussed, this is the big picture approach to health and well being. Thus to understand our complex society we can now look at many health issues from the public health perspective. A big problem can be qualified within this context by seeing that there is a way to prevent it, treat it and allocate resources to accomplish both of these things.

This reminds me why I do what I do. As a public health professional I work to find ways that we can be most effective in benefiting the lives of others. Much of what I do, which many not be different in other fields sets the foreground for the future. In the course of my career I may have made changes or built up assets that demonstrate increased capacity. However, the true change will come after me and that is from the people that I've taught, ideals that have been instilled and will be measured by my ability to pass this on. To strive for this I must acknowledge that without the insights, leadership and involvement of those who I wish to impact I can never leave behind what I've set out to accomplish.

                                                                              

I listened to a lecture this afternoon on youth substance abuse trends and the speaker talked about how the world is not the way it was when he was growing up. He pointed to the reality that one wrong decision could potentially lead to life threatening diseases or other major consequences. This is true in many ways, but what he referred to through this is that we are no longer communities of caring, and we don't know our neighbors. Given that public health seeks to interpret and find solutions for our communities, to do so we must build them. If we can give people the opportunity to walk hand in hand and join in an effort to enrich themselves, this will be sustainable. As I always say, without each other we only have ourselves and alone we can only accomplish so much. In the context of this issue let's remember that although we work in an industry that is large and complex, the simplest and most effective solutions lie within the hearts and minds of those we serve.

While following Obama's visit to Europe for the G20 summit and others, we are seeing that he has successfully followed through on his popularity in this region of the world. Prior to visiting the region he demonstrated positive relationships with Great Britain, Brazil and a few others and now is building on that while on the road. A crucial sign of this was a clearly positive press conference and a sign of being on good terms with French President Sarcozy. Obama showed his popularity at a town hall in France. The news reports are constantly saying that this is a true sign of change, in that these such events would have never taken place in recent years of the Bush Administration. This shows that the major economies in the world are coming together during a paramount time in our economic world history.

Now, what does this mean for our country? I feel as though this visit will help Obama and his administration to earn further credibility in the US and among our key leaders. The timing of this visit couldn't have been better. Obama has been faced with sharp criticism over his spending plans, handling of the TARP legislation and a recent forced resignation of the long time General Motors CEO. Although  in some ways rightfully so, the Administration has had significant push back from our politicians, which in many ways is shifting the blame from past mistakes made by these same legislators. Yet, given that Obama has gone out of his way to be transparent, it is important that we recognize this, allow him to prove himself and capitalize on the opportunity to work with and not against our President.



                                                              

As such, the fact that our President has continued to show poise and positivity among key leaders in this world, reaches beyond the rock star persona of Barack Obama. Yes, there's always the press focusing on Michelle Obama as a fashion icon. Yet it is clear in the presence of the President and First Lady, that they are strong and capable. Let's hope that this visit will encourage our nations' leaders to step back and further trust our new President.

Not only did Obama demonstrate grace in the presence of continued pressure, he has been strong on his policies, especially those towards nuclear proliferation and the war in Afghanistan. This morning's news brought attention to the situation in South Korea. Given that the Administration now has strong allies amongst world leaders, I hope this partnership will provide support to these challenges. It is hugely important that Gordon Brown remains a strong ally in addressing our economic downfall, a renewed partnership has developed with France and we are now engaging in open dialogue with Russia. Yet, we must acknowledge our shortfalls, challenges that exist within the UN and the large disparity amongst the developing world. In a falling economy, 75% of the world which lives on less than $1 a day is grossly impacted. This causes desperation, as we've seen in acts of violence as well as the need to assert egoes among world leaders. Thus, we must also maintain a focus on justice, and hope that these positive developments will not allow developed countries to undermine citizens of the world.

Recent news of the State of Iowa Supreme Court rejecting a ban on gay marriage and determining this to be unconstitutional, has brought shock and suprise to many Americans. Most may have thought that a midwestern state would be the least likely to pioneer this legislation among two other states- Massachussets and New Hampshire. This is moving, especially amongst the controversy of California's proposition 8 passing and repealling the supreme court ruling that banning gay marriage is unconstitutional. It brings up an important question, and relates to my continued focus on denying or preventing access to basic rights and resources as a way of negatively impacting the health of Americans.

The debate over gay marriage is multi-faceted, political and based on a history of opression and discrimination in this country. The 2008 Presidential election brought with it a response of mixed emotions amongst civil rights activists. A huge stride was made toward equality amongst African Americans and people of color, yet a continual (second time a proposition like this has passed in CA) step back for equal rights in California was evident. This in itself is ironic, given that in recent history inter-racial marriage was against the law. Thus as we move towards racial equality, we are regressing in the same direction in context with our history, particularly as it relates to marriage.

                                                                       

Opposition to gay marriage is strongly rooted in religious views defining marriage as a sacred union between a man and woman. Yet, with a clear separation of church and state in this country, is it right to legislate these moral tenants? Personally, I believe this is simply unethical. This can be justified within the context of the laws of democracy and equal access to civil liberties. A ban on gay marriage prevents a same sex couple from attaining many rights and resources. These include: shared custody of children, coverage on health and life insurance benefits, shared ownership of property and the ability to save costs on mortgages, financial assetts and accounts and from what I understand tax benefits. Same sex partners can be prevented from making medical decisions on behalf of their spouse and even the ability to be present as a family member while the other is in the hospital, especially under critical care.

Is this moral? Would denying Americans these rights be in support of the values and principles of Christian or other religious beliefs? This I believe, is what we must seek to answer. From the practical stand point, religious institutions have the choice as to whether they will recognize these unions and oversee a ceremonial same sex marriage. Yet, the provision that a state government has over marriage is entirely civil. Some say that using the term marriage as a way of also defining a same sex couple- will undermine their religious community. However, denying basic human rights to a large segment of our population (as much as 10%) is undermining, unjust and contradictory to our judeo-christian and overall theological world.

In looking at this issue, we must force ourselves to view it from this stand point. Many politicians like Obama, Joe Biden and even Sarah Palin have said they do not condone gay marriage, yet they are not inclined to carry this view point over to the regulation of our government's law. This is where our democratic principles apply. Can we simply say that respect for others and allowing our neighbors to live their lives as they choose is at the core? Given this, shouldn't we allow our fellow citizens the right to equality? Most will anwer yes, and thus we must ask ourselves how we can acheive this as a democratic society. Let us not fool ourselves to believe that this is a one sided issue. It is human, civil, ethical and essential.

As an undergrad I had the opportunity to do research on theories behind the advent of diabetes as a modern day health issue. Anthropological theory proposes that diabetes has become a disease of civilization due to a biological adaptation from hunter gatherers who needed to store fat during times of plenty in order to accomodate for times when less food was available. This feast or famine hypothesis relates to the negative impact that eating in excess or consuming extra calories has on our long term health. Evidence was seen in Native Americans exhibiting high incidence of diabetes as a major health problem within this indigenous community- the closest descendants of hunter gatherers. As I've discussed before, changes in modern human culture have in many ways benefitted the efficiency and productivity of human society, however this has not occured in a sustainable manner. Rapid expansion has led to a division in health and wealth that is now starting to bleed through economic barriers.

What I think has happened, much like the aforementioned theory is that we've worked against our natural inclinations to develop a society that runs on the newest and greatest. Thus, when we measure our success as individuals by wealth and not primarily by health, a need to attain success is second to our health. However, people that in many ways are more affected by modern day health issues are the least wealthy. Essentially, those who have a strong desire to become wealthy are in fact sacrificing the health of others to do so. 

                         

This creates an opportunity. When wealth is no longer so easily attainable, or the facade of wealth through loans and debt is no longer a possiblity we must shift the way in which we exist. More young people are voting for the sake of their future and going into national service and volunteerism during a waining job market. Going green has become a growing trend, and although I feel it is sad that people don't start to think more about this until it becomes popular, this lifestyle change is needed and beneficial.

Our next major step was I feel in electing a president who has made a strong commitment to restoring justice and equality in the US. Weekly we hear of stories where the President's reputation and capability is put to the test. The system that has perputuated many of the problems we are faced with today cannot change in less than 90 days and definitely not by one person alone. As I continue to emphasize, in order to make this change a reality for our future generations, let us remember our history, recall why and how we can preserve and protect our environment. This environment is our community, our home and key to true health and wealth. Thus to unlock the answers to our future we can look to our past, identify where we have made mistakes and use those as an opportunity to work for a shift in the right direction. To do this we must have faith and most of all patience. If we can look to history as a lesson for the future, maybe we can prevent ourselves from doubting many of the steps we are now taking.