Most of us know the facts: 47 million Americans are without health insurance, we currently have the highest job loss rate since the 1980’s and Obama’s proposed budget is shaking up the hearts and minds of the wealthiest Americans. What do we do about this? With so many Americans out of work where they would be more likely to get health insurance from their employers, and companies are going out of business because of health care costs we need to do something. Health care costs have sky rocketed due to uninsured accessing services at the ER and the culture of extensive lab work and use of expensive medical technologies that has evolved in the health care setting. Advances in medical technology have allowed practitioners and providers to streamline medical records, increase accuracy for detecting problems and quickly find the solution. However these technologies are often expensive and impossible for uninsured patients to pay for. We’ve heard stories of individuals diagnosed and treated for a serious illness who have gone bankrupt or lost all of their savings because of medical bills. We’ve also heard about life saving procedures being denied by health insurance companies to save cost and put money into the pockets of executives who’ve demonstrated “efficiency.”

What do we do about this? Advances in technology, the capitalist economy and education and research in this country have made so many contributions  to the landscape of our country, which include increasing the economic divide and limiting access to resources amongst middle and low income Americans. So the Obama administration, like they have with banks and the auto industry who’ve demonstrated irresponsible and dishonest spending are proposing to increase oversight on healthcare provision and thus limit the ability that providers have to implement cutting edge medical technology. This will serve to drive down costs and increase access to care among the uninsured. With the goal of making sure individuals obtain coverage and their coverage can be maintained given that costs decrease or are reasonable enough to cover an increased number of insured individuals.

Another cost saving mechanism is preventive care. One crucial measure for ensuring healthcare is accessed at an early age and prior to a problem or emergent health concern, is the SCHIP bill providing guaranteed health coverage for America’s children and youth. In addition to this, Americans need to obtain a primary care physician, complete regular checkup’s and commit to a lifestyle that will increase likelyhood of avoiding preventable health problems. Given the state that our economy and America’s healthcare is in, we need something to happen now. Obama is following through with his commitment to invest in healthcare however this means that a small portion of Americans will be paying for healthcare amongst the majority. Is this fair? I’m not sure but is it fair that most Americans are not able to access care? Is it fair that the high cost of healthcare is due to uninsured Americans accessing care in the emergency room? Is this justified if a large number of Americans are making irresponsible choices about their health? The bottom line is that many other facets of today’s culture have contributed to poor health in this country. We can be thankful that our country has been able to find solutions to and eradicate diseases that are killing a majority of the developing world. However, this country is well behind most other industrial nations. This is the question that we must answer and find a solution that is sustainable. We have the ability to act, so should we make sacrifices for the sake of others.

After you read this be sure to visit The Kathleen Show website to find out about their new
Prevention not Prescriptions Tuesday program.

In the past 10-15 years public health has come to the forefront as a major industry for social change. So has an awareness regarding our choices as consumers connecting with growing patterns of preventable disease. The tobacco and fast food industries capitalized on the industrial revolution by engaging in heavy media campaigns infiltrating into the lives of everyday Americans. Going to the drive through for dinner became a regular thing for many parents and families and smoking maintained popularity among adults and teens. Strategic efforts to market tobacco and junk food successfully clouded the judgement of many.

A rise in rates of chronic and preventable disease, began to expose how entrenched had these industries had become in the fabric of American culture. Public health and consumer advocates began to investigate this question and found that these industries had stealthly incorporated their product marketing strategies into US media, campaign finance and the global market. This was not an easy fight. These industries had become so large that heavy endorsement deals and millions of dollars funding lobbyists could not match up to grass roots efforts exposing corporations who knowingly sold and brokered toxic substances to the American public. Yet, beginning in the 90’s efforts to bring to light these truths through documentaries, dramatic portrayals, community organizing and marketing campaigns empowered Americans to sue these industries and call out politicians and others who condone the sale and marketing of harmful products.



These efforts set the tone for a heightened awareness and ultimately funneled millions of dollars into tobacco control and prevention, stricter regulation and censorship of lobbying and media marketing. This has set the stage for prevention and the next issue to tackle is alcohol. Among prevention advocates, this we know is a complex issue. Alcohol is a mainstay of American culture and many could say that folks doing work to prevent and control its associated harms are prohibitionists. However, we can’t deny that in the past 20 years, alcohol-the drug has been sold and marketed as a drink and a social lubricant. This is where it becomes a harm. Not only is alcohol demonized, which many youth will say makes them want to drink more, but it is the way in which we drink.

The college atmosphere has changed, and expectations are much higher for young people to attend, succeed and be able to compete in the real world. College days aren’t like animal house, however this is still a part of the youth culture. We’ve learned from our successes and we now have a base from which we can apply this work. We must empower young people to consider how our culture and social atmosphere influences their choices. A chance for a future generation to decide how to drink, when and where to do it safely and responsibly. We can combat the misperceptions and call out irresponsible marketing and lobbyist activities. Thus our challenge is to bring the public to this level of readiness. A culture war on civil ground.

As I walk around where I work and in other public places I see people with MP3 players, talking on cell phones and generally on a straight and narrow path to get things done. This makes me question why many people today may always feel like they should have something to do or should have some kind of stimulus. The phrase stop and smell the roses comes to mind. We've become an on the go quick fix culture, which makes for the ability to accomplish things and stand out as a competitive and motivated culture. However, does this contribute to increased stress in our environment, pressure us to focus on quick fix solutions and ultimately work against our health? Maybe so, but how does this really play out into our daily lives?

This is a big question, yet I think I can point to a few trends in modern American health that may correlate with this issue. Today's youth are from a generation of stimulus overload. No longer is growing up just about going to school, playing with the neighborhood kids and if you're lucky  enough, enjoying sports and recreational activities. Children and young people are growing up in a world filled with TV, internet, gaming, testing in the classroom and this general standard for perfection based on performance and acheiving the highest level of success. They are growing up in a home where in most cases both parents are working and they may also be a product of divorce or being raised by a single parent. In many cases as well parents or other adult family members are facing cancer or other chronic diseases such as obesity, diabetes, heart disease and related conditions.

Health issues among our children that have arisen in the past ten years are asthma, allergies and behavioral problems such as ADD/ADHD. The ability to detect and treat these health issues is due to advances in medical science. They are also due to an environment filled with many distractions, high expectations and in general a world that is centered around synthetics. This is not to undermine the major advances in technology and innovation, yet from the health perspective and where I think stress- both on our bodies and within our daily lives- is a key indicator for the development of effective prevention based interventions.

Again this goes back to the idea that this is a complex issue. However, I think there are things that we as adults and healthcare professionals can do to encourage the use of principles that we grew up with and apply them to the habits we instill in our children. Taking the time to invest in relationships, talking to our children and encouraging them to interact with others and their environment, will help to reduce stress, provide perspective and allow us to remember where we came from. I think this is paramount. So consider what you can do. As we are seeing, hearing and learning from our president- going to the source can lead to solutions. Yet, until we structure our daily lives around this concept we may often succumb to the pressures that are impacting our health and in many ways puts this stress on our future generations. The trying times we are experiencing now, are an opportunity to utilize what we once knew and apply it to what we know today.

Upon news that Bank of America and Citigroup are on a downward spiral, the question has come back as to whether the US government will have to nationalize our banking system. I recently had some e-mail conversations with someone who's been working with key individuals in the health sector to address some of the health care reforms in the stimulus package. Recent reforms under the new administration clearly steer towards stricter government controls over the private sector, which aim to increase access and efficiency of banking, public education, health care and employment. The conservative ideal of "no big government" is clearly being undermined by this approach, which urges the right to ask whether this is justified or "right."

Healthcare strongly emphasizes access, and our ability to stay healthy and attain proper treatment depends largely on a number of other economic factors. Yet, do these changes really limit our economy in terms of the ability to diversify the market, increase competition and allow trained professionals to provide services in a way that relies more on their expertise than blanket standards with tighter controls? This is an important question to ask and consider whether those who are resistant are reacting more to this idea of change, that at first may seem uncomfortable.

The principle of no big government can be looked at in comparison to the approach from the Bush administration. The conservative method of governmental control and economic regulation emphasizes tax cuts and private sector investments. However, this proved to be unsuccesful as our government has invested more money into national security, counter-terrorism and "democratization of the middle east" than we ever have. This in combination with continued commitments of billions of dollars in foreign aid has vastly increased our national debt, and ultimately shifted our government's focus away from the private sector.

Thus, with the advent of a global and free market economy, corporations saved millions by investing capital in outsourcing jobs, increasing imports and production in developing countries. Not only did this narrow the job market, but it may have given investors, lendors and banks the ability to stimulate national growth by loaning more money than before and fooling middle class Americans into thinking that this would be a sustainable method for increasing their own capital. Greed got the best of the private sector and as our stock markets crashed, values went down and prices went up. Given all of this, it's crucial to consider that a shift in governmental controls from regulating public life and beefing up military and security operations is being shifted to the basic structures of our national government. This serves to reinforce the principles of democracy by increasing access to goods and services for Americans, which in effect will give citizens the ability to weigh in on the government's ability to directly serve them. Until capitalism can regain it's momentum, we must serve to increase Americans individual capital and ultimately their livelihood.

Obama provides a map with the number of jobs that will be saved and/or created through the stimulus package:

http://my.barackobama.com/page/community/post/obamaforamerica/gGxRfX

Family history is a term in health that we connect with health conditions, their hereditary nature; which can explain reasons for particular body frame, eye color, complexion, chronic disease, addiction, mental health, child rearing practices and genetic conditions. With advances in medical care and preventive medicine, testing for heredity now begans before birth with genetic counseling and can be traced through further analysis. Parents and practitioners can plan any necessary interventions based on the outcome of this process. Understanding what to look out for, how to recognize its early stages of development and tracking the expression of certain genetic traits, can allow individuals to increase their longevity. However, family history and generational roots stems from the intangibles as well. Anthropology emphasizes geneology in tracing settlement patterns, family trades, linguistic trends and the many aspects of our family history that contribute to our cultural history.

This is something that in my adult years I have felt very connected to. America is called the melting pot, a concept that may seem intriguing however it has led to much loss of culture and family history throughout the chronology of this nation. Essentially those who settled here from other parts of the world are melted into a mold of english speaking consumerism, aimed at increasing ability to succeed and be a part of the dominant culture. Given the diversity of cultures and ethnicities in the US, many Americans are from a mixed background of national origins and sometimes struggle to identify with their ancestors. Others have strong traditions for marrying within their nationalities and develop a sense of pride in their decendence. However, when it comes down to it they may be unrecognize and considered outsiders from the dominant American culture.

My own roots come from Russian Jewish heritage on my Mom's side and primarily British Protestant descendence  on my Dad's side. I never got to know most of my relatives on either side of the family. Both of my grandparents moved from the east coast and midwest to Tucson Arizona when my parents where young or before they were born. My father was the youngest in his family and many of my mother's relatives suffered from chronic disease and passed away. However I identify strongly with my Jewish roots and was lucky enough to inherit the last name of my grandfather Edward H. Spicer.

http://www.nap.edu/readingroom.php?book=biomems&page=espicer.html
Recently I have come back to the idea of carrying forward the work of my grandparents in anthropology as they have contributed largely to the development of applied anthropology and understanding of Native Americans. As I engage in my own efforts to achieve the ideal American lifestyle, I'm reminded that looking back at my roots can help guide and reinforce my goals and future within the context of where I came from. Does your family history inform your adult choices today? We learn so much from our parents, grandparents and ancestors and choose how we apply that to ourselves and our adult life. However, do Americans tend to give into the melting pot and idea of  re-inventing the wheel? What real purpose does this serve? In every society there is a dominant culture and in many cases, minority cultures end up being down played or diminished. Yet, I think it is important to look back at our own families and consider how we want to apply that history to our own lives.

Today I came back to thinking about what brought me to where I am right now. In the past year and a half so much has changed in my life and as I work to forge my way in the world of community work I'm reminded why I do what I do and where I am. I thought back to late summer of 2007 when I got the call to be a blood stem cell donor for a woman with Leukemia. The whole process changed my life and since then, I feel like my perspective has changed. I learned to appreciate life and take advantage of each day. Since then I've improved my health, progressed in my career , found a relationship and along the way have done my best to stay connected with what motivated me to get here. I can remember writing a letter to my blood stem cell recipient and talking about how I had been through a lot in my life and it wasn't easy even in the process leading up to doing the donation. However, the experience of possibly saving someone's life put it all into perspective.


As members of a community where some facets have distinct differences, we must remember that there are others out there who are struggling. The power of helping others is imeasurable and in many cases when you can do something knowing you are helping without meeting that person or just hearing their story, it can be life changing. Giving a can of food or a piece of clothing doesn't go unappreciated or unnoticed however, our reason for doing so should be about what those gifts can do. One can of food can feed the child of a single mother who works two jobs and barely has time to sleep while she struggles to put food on the table. A monetary donation can pay for a procedure that will provide hope to someone suffering from a life threatening illness and is without health insurance.

The reality is that we want to connect with the issue and see that our contribution will produce results. However, this is the power of giving. We can decide how we want to contribute and if we imagine what impact our dedication can have, this may motivate us to do what we are capable of to instill that hope. When someone receives an anonymous gift they are given a sign that someone cares, they don't have to say thank you but they can be thankful for what they've received. Someone who isn't able to rely on others to survive can be renewed with faith when they are given something without asking or without knowing who it came from. So, when you are asked to help or you think about the impact you are making remember that you can imagine anything.

As I listen to and watch updates on the current economic crisis I try to remind myself that every generation experiences war and strife. However, I’ve started to ask myself why this is the case. In the context of our current situation in the US, we hear all the time that there were many signs along the way that were predicting the severe economic, health and political outcomes we are now seeing. Much effort has been made towards population control, environmental conservation and increasing efficiency for nearly 40 years. However, with the technology boom we became greedier and hungrier. In that, information, marketing, goods and resources have become so easily and readily accessible. This has impacted our health and way of living and ultimately disengaged our young people from civic participation.

In my prior postings I talked about the importance of innovation and in the context of transparent and sustainable planning and implementation. This relates to the idea that it is essential to stand out while ensuring that your work will continue to have a place for itself. We are now forced to cut back, consolidate and hone in the broad reach with which we have extended ourselves. This has been motivated by a grass roots effort to change the face of our nation. Obama proved that by reaching out to the American people and instilling hope back into the hearts and minds of Americans, he can gain the confidence of our people. Human nature is to judge others by their actions beyond their appearance, however with image and materialism as the driving force of our culture we have lost site of what matters. This is why we must work to change our outlook and in a way that can inform the future.

On college campuses we are seeing the impacts of a fast paced and high pressure environment that is resulting in acts of violence and increased numbers of mental health and other risks among our nation’s young people. Freedom, individualism and a dominant capitalistic culture has created an environment where we can’t get enough, we put ourselves before others and we are working towards the unattainable- perfection.

Health in its core principles maintains a holistic approach to our well being. In many approaches we now emphasize the importance of the mind body and spirit; new and alternative medical practices have begun to influence our health belief system. However, we continue to struggle to find a balance. This may be in part due to our lack of ability to connect the future with the past. In order to make right the wrongs of prior generations we must use these ways of living and working as a method for informing the future. A free market economy opens up our environment to increased competition and opportunity, however we have left our competitors behind when we refuse to ask them for any help or support. Thus, lets not turn our back on the past and work to create history that attempts to learn or grow the future.

In the social sciences we often talk about health equality or equal access to care. What does this really mean? Is it possible? How can we attain this amorphous goal? This answer is not quantifiable, and will differ depending on the population, demographics and resource capacity. However, from my experience and what we've seen in recent years, there are certain characteristics of our country, it's systems and influence on other parts of the world that may provide some clarity or perspective on this issue. Health disparities has become one of the emerging field within public health. This field of study and practice looks at health trends among minority populations, low income and other vulnerable communities to identify based on history and culture the factors that contribute to these health trends. It seeks to answer why minority and other vulnerable populations in the US have demonstrated certain health trends in relation cancer, diabetes, cardiovascular disease, lowered life expectancy, addiction and substance abuse, high rates of infant and maternal mortality and morbidity and other communicable and infectious diseases. These factors relate to cultural, economic, political, geographical and genetics/heridity. This serves to identify where disparities exist and how they can be addressed, and ultimately controlled and prevented.

How does this relate to today's topic? Health disparities work shows that the systems we rely on to prevent, reduce and control the rates of communicable, infectious and chronic disease are not fully capable of addressing these gaps in a comprehensive and effective manner. Never  in one's lifetime or adulthood will we be able to eliminate the impact of any serious health issues affecting a population, however we can work to create an even playing field.  A key point of entry here is access. It's not only access to the resources themselves, but at what point are these populations seeking care, is it provided in a way that will produce long term benefits and how does this relate to the efficacy of control and prevention? An example is that health care access trends have shown that a large number of limited english proficient latino and other immigrants commonly access care through emergency room visits. They are often without health insurance and in many cases may not receive adequate care to address other health needs that are not acute or emergent. In relation to that, any American or individual who accesses care primarily in this manner or simply without health insurance will be faced with huge health bills, more stress and significant challenges with sustaining a healthy lifestyle.


This may contribute to the reason why many Americans do not access healthcare regularly and prior to specific concerns. Each community finds it's own way to adapt and may seek out non traditional or language and culturally appropriate care. Many know that our health care system is beauracratic, difficult to access and too costly for most Americans. However, to address the gap between the rich and the poor the white and non white, american and immigrant, we must pay attention to the most vulnerable, look at the less vulnerable and seek assistance from the least vulnerable across a continuum of control and prevention.

The complexities of this issue can become quite detailed multifaceted and political. However, that is the point. To make real and sustainable change we must analyze our entire system and it's major structures to develop consistent, effective fair and just change. Thus as I've mentioned before, we must assess the core needs of our communities and look at ways we can make improvements based on all aspects that are contributing to the problem and lending a solution in terms of individual and community, synthetic and natural. If our systems are funding efforts that are affecting the health of our communities we must hold them accountable and advocate for them to contribute not only by improving the health and safety of their facilities but by utilizing their resources to give back to the community. This can start from the ground up, by highlighting the work that is already being done and funneling these models and resources into areas where a gaps are identified. Public health prevention provides us with a key tool: we can use research and evidence to show our stakeholders the extent of the problem, propose a solution and work together to create positive and sustainable results.

When we work to improve the health and well being of our communities, they must be a part of this process. Health education does not work with print materials or one time events. Just as we interact directly with our communities when we provide them with treatment, education, and avenues to be productive and law abiding citizens we must invest in empowering our neighbors and fellow citizens. This means joining hand in hand to honor ourselves for what we've accomplished and talk about ways we can work together to reach our potential. It's not easy but it's possible, it takes time but it's worth it.

New York Department of Health and Mental Hygiene is finding new and innovative ways to reach youth with health messages, resources and forums for dialogue:

http://www.nytimes.com/2009/02/12/nyregion/12econdom.html?_r=1&partner=rss