Author: Crystal Bentley

Public Health is a journey; Let’s remember the path may be as important as the desitination

Graduation season is upon us, and this year I’m one of the people adding add extra letters behind their names.  During this transition, I find myself feeling like I’m standing on the top of a mountain. I’ve completed the climb that is my MPH program, and now I’m staring at what’s in front of me.

 

Mountain views are this special phenomenon where you can many destinations.  Because you can see them so clearly, they seem close and easily attainable.  However, only a few steps toward those goals means that you dip into lower elevations, and they hide below the treeline.  That doesn’t mean that the places don’t exist anymore.  It doesn’t mean that they’re unreachable.  It just means that you’ve got to have the tenacity to believe you can get to that destination without being able to see it clearly.  You may get glimpses every once in a while as you come to a clearing on the trail, but most of the time, you have to trust in yourself that your efforts will be successful and you can get there.

For me, this mountain hike can be a metaphor for public health.  We’re in the business of having the grand goal of healthy people and a healthy world, but the path forward requires a many small incremental changes- much like taking a hike through the woods. Even though we’re moving forward, we can’t always see the clear way forward.  We can’t watch our benchmark and measure how close we’re getting. We just have to trust that we’re getting there.  It can be frustrating to seem like that next peak keeps moving farther and farther away, but that does not take away from the experiences on our path.  Just as hikes through the woods may have small little “happys” like a serene lake, a gorgeous waterfall, or a baby fawn, our small public health victories should be celebrated as well.

As I face graduation, I see so many destinations that I could go, but I’m sure that it will be easy to get lost in the woods of bureaucracy.  My goal is to keep moving forward, and even if I don’t get to that next big public health breakthrough, I will still enjoy the small ways I can help along the way.

old cemetery with tree

Thanos provided eco-friendly burials, here’s how mortals can do the same

As I prepare to see Avengers Endgame this weekend, I find myself reflecting on the last movie and the way so many died in Infinity War.  As I recall half of the population turning to dust, I remember the phrase we hear at funerals, “Ashes to ashes.  Dust to dust.”  Then my eternal optimist tendencies kick in and I think, “At least Thanos was eco-friendly,” to which my public health brain immediately adds “Are we being eco-friendly with our deceased loved ones?” While, this admittedly provides insight into the strangeness of my brain, this is a topic we really should speak about more.

As it turns out, no we’re not eco-friendly.  We’re polluting the environment with our dead.  In America alone, we’re burying 20 million feet of wood, 4.3 million gallons of embalming fluids, 1.6 million tons of reinforced concreted, 17,000 tons of copper and bronze, and 64,500 tons of copper and steel along with our loved ones. These embalming fluids can seep into the ground, and the plots themselves take up lots of room which is increasing land shortages in urban areas.  While cremation may be slightly more eco-friendly it still releases chemicals like carbon dioxide and mercury into the air, and uses enough fuel to fill a Toyata RAV4’s tank twice.

Luckily, there is an emerging market in green funerals.  With these burials, the deceased are placed in the ground without any preservatives and little or no additional coverings.  While this may bring up concerns about polluting ground water, the World Health Organization states that it is safe as long as the person is buried at least 820 feet away from a drinking water supply, 100 feet away from a body of water, 1 meter above the water table and 1 meter below the earth’s surface.  If you’re concerned about laws, no state requires embalming, and most will allow burial without a shroud.

So there you have it, you can be just as eco-friendly as Thanos if you’d like.

 

 

 

https://www.nytimes.com/2018/03/22/smarter-living/green-funeral-burial-environment.html

 

https://www.businessinsider.com/burying-dead-bodies-environment-funeral-conservation-2015-10#cremation-is-not-much-better-5

 

https://www.theatlantic.com/technology/archive/2014/10/how-to-be-eco-friendly-when-youre-dead/382120/

 

https://www.forbes.com/sites/bisnow/2017/11/03/urban-cemeteries-running-out-of-space-as-baby-boomers-enter-twilight-years/#4ed7aea9579c

 

http://essentialelements.naccho.org/wp-content/uploads/2018/11/Environmental-Health-Implications-of-Green-Burials-K.-Koepenick-Balt-Co-DOH-11-7-18.pdf

Philadelphia attempting to open supervised injection facility amid legal challenges

Safehouse, a non-profit group in Philadelphia is attempting to open a supervised injection facility for people with opioid addiction to use these drugs in a safer manner.  Their plan is to allow people to use opioids in the presence of trained healthcare providers who can recognize and treat opioid overdoses before they become deadly.  The group also believes that this will allow them to build trust with the people who use their facility, which will allow them to better connect those with drug addiction to other treatments and start them on the path to recovery.

A similar facility in Vancouver, Canada has shown reduced overdoses, more connections to recovery options, decreases infectious disease transmission, reduced public disorder.  Additionally, there were no increases in crime or promotion of drug injections around the Vancouver facility.   An unsanctioned site in the United States has also reduced public disposal of used needles and prevented opioid overdose deaths.

Even though sites like this may have helped people in the past, the Philadelphia group is facing legal challenges that may prevent them from opening.  Currently, the Trump administration is suing Safehouse citing that it is illegal to own property where drugs are used.  The non-profit group is counter-suing citing religious freedom, stating Judeo-Christian beliefs of preserving life.

The toll of college athletics

With the recent NCAA basketball tournament and Auburn gymnast Samantha Cerio breaking both legs during competition, college sports are trending on the internet right now.  As we watch video of amazing basketball plays and a twenty-two year old’s career ending injury, it makes us wonder, “Just how much do college athletes put their bodies through for their sports?”

 

According to the CDC, among twenty-five college sports, there are an average of 1,053,370 injuries each year, and roughly 21% require recovery lasting longer than 1 week.  Typically, injuries incurred during competition are worse than those acquired during practice. Athletes put their bodies through this potential lifelong harm, and they are not allowed compensation above tuition, room and board, and cost of living stipends.

 

When looking at the lifelong costs of participating in college athletics, those who faced injury often face limited physical activity later in life.  Additionally, former athletes often report worse quality of life as they age when compared to the general public, and in some ways retirement from the sport has been compared with experiencing a death.  As athletes face retirement from the sport, they often feel unprepared to make the transition and struggle with maintaining a self-identity after sports.

 

Currently college sports is a multi-billion dollar per year industry, and we fans are a big part of this.  Sports help us unite friends, families, and communities as we root for our favorite teams.  Watching these athletes brings us joy and occasional heartache.  Some of us think of them as an extension of our own families.  However, if we care ABOUT them this much, why aren’t we doing more to care FOR them- in the forms of compensation or at least helping them transition into the ranks of us normal people when the sport is over?

 

 

 

https://www.cbsnews.com/news/auburn-gymnast-breaks-both-legs-samantha-cerio-auburn-college-gymnast-injury-retires-video/

 

https://www.dreshare.com/samantha-cerio/

 

https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6448a2.htm

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5582695/

 

https://www.washingtonpost.com/outlook/the-ncaa-says-paying-athletes-hurts-their-education-thats-laughable/2018/09/20/147f26c0-bb80-11e8-a8aa-860695e7f3fc_story.html?noredirect=on&utm_term=.3c0236937eb0

UNC Science Expo Preview: Gillings Project Management Course Presenting 4 booths

Each year, University of North Carolina at Chapel Hill’s Morehead Planetarium hosts the UNC science expo with over 100 hands-on activities that teach people of all ages about science.  This year’s event includes a curiosity classroom, tours of 11 different labs on campus, and many exhibitor booths.

For the eighth year in a row, Gillings School of Public Health’s project management course, instructed by Lori Evarts, will host booths at the expo.  They always seek to demonstrate the connections between public health, STEM, and everyday life through interactive projects, and this year is no different.  Keep reading for descriptions of each of the four booths.

  1. Vaccinate- Don’t Wait: If you’re a fan of The Price is Right, then you may like this team’s Plinko board to demonstrate the concept of herd immunity. They’re also covering how vaccines work and vaccine safety.
  2. The Distribution of Health: Live life in someone else’s shoes for a little while. This group has a board game to demonstrate the implications of poor access to healthcare.
  3. Mindfulness Meditation: Meditation can have positive impacts on your health and well-being. Come by this booth for a short, guided meditation to learn more.
  4. Water You Waiting For? This group covers emergency preparedness and water quality with a great diorama and twister game. Stop by and learn a lot.

The UNC science expo will be this Saturday, April 6 from 11am-4pm.  The event is free to all.  Expo booths will be set up along East Cameron Drive on UNC’s campus.

 

*disclosure statement: the author is currently taking the course featured in this post

 

 

http://moreheadplanetarium.org/uncsciexpo 

The bond market, public health, and the future

Some may view public health and the bond market as opposites, but they are surprisingly intertwined.  This week the yield curve inverted, meaning that yields from long-term bonds dropped lower than those from short-term bonds.  Historically, this inversion signals a likely recession in the next 1-2 years.  While this news may lead to thoughts of recession preparation tactics such as getting a side job or diversifying investments, it may not necessarily trigger public health concerns.

However, this is a time to build our public health programs.  Higher unemployment numbers often accompany recessions.  These higher unemployment numbers are associated with individuals choosing fast food and junk food over fruits and vegetables.  Additionally, without jobs (and their associated health insurance), people seek medical and dental care less often.  Job loss, including recession related loss, is associated with increased housing and food insecurity– both of which are associated with poor health outcomes.  Suicide rates also increase during recessions.  Therefore, it may be time to start investing in programs for mental health, nutrition, and housing stability.  Surprisingly, during recessions all-cause mortality typically decreases. Some predict that this is due to fewer accidents, including on the job and commuter traffic accidents.

Though people face negative health effects associated with economic hardship during recessions, some evidence suggests they try to mitigate these issues through increased exercise and appropriate sleep habits.  Public health practitioners should find this news encouraging as unemployed people may have time to adopt and normalize healthy behaviors into their lifestyles (action or maintenance stage of the transtheoretical model for the theory fans out there).  However, the focus shouldn’t end there.  Though there is a dearth of literature outlining the impact of job re-entry on the healthy behaviors adopted during unemployment, it is plausible to believe that if available time led to healthier behaviors, then additional time devoted to a job may impede continued behavior practice.   As we want people to return to work, public health practitioners may focus on interventions that include implementation intentions, specifically “if-then” statements championed by P.M. Gollwitzer.  For instance, If I get a full-time job, then I’ll exercise after work.  These statements have been shown to help people overcome changes that would otherwise be barriers to maintaining health lifestyles.

 

 

 

https://www.barrons.com/articles/yield-curve-inversion-51553272263

https://money.cnn.com/2018/08/13/pf/recession-ready/index.html

 

https://journals.sagepub.com/doi/pdf/10.1177/0002716213500212?casa_token=k0nHCQU-ijcAAAAA:YuUEPiqY76g0TFLawgdQB4ObzmOeh4-8zJniLJ-YR2WP7swJVy6gLQN4UZrpXBr86q32d1HcLrU

 

http://kops.uni-konstanz.de/bitstream/handle/123456789/10101/99Goll_ImpInt.pdf?sequence=1&isAllowed=y

Feeling Mad this March? Health Effects of Prolonged Anger

Here at UNC, March Madness is always a big deal.  In honor of the impending brackets, abundance of basketball, and other festivities, this post focuses on madness- specifically anger- and how it impacts your health.

 

While anger itself is a normal emotion and has some occasional benefits, prolonged anger can hurt your health and well-being.  It affects your physical health because anger increases blood pressure and heart rate, which can harm your heart over time.   It’s also been linked to depression, anxiety, insomnia, and decreased sexual performance.

If you find yourself feeling angry frequently, the Mayo Clinic offers these 10 tips to help temper your anger:

  1. Think before you speak
  2. Calm down and then express your anger
  3. Exercise
  4. Give yourself breaks- especially during stressful times
  5. Identify solutions to the problem
  6. Use “I” statements when speaking
  7. Forgive the one who angered you
  8. Diffuse tension with humor
  9. Use relaxation techniques like repeating a calming phrase, listening to music, or journaling
  10. Know when to seek help. Counseling may be helpful for you if you’re having trouble controlling your anger.

Remember, if your team doesn’t win the championship this year, don’t hold a grudge.  Your mind and body will thank you for it.

 

https://health.usnews.com/wellness/mind/articles/2017-10-26/the-physical-and-mental-toll-of-being-angry-all-the-time

https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/anger-management/art-20045434

green plants spilling out of a mortar and pestle

Free, all-natural, non-pharmaceutical intervention named the “blockbuster drug of the century”

The “Blockbuster Drug of the Century,” is all natural, has no negative side effects and is not the least bit new.  However, it’s getting more and more attention.  It’s nothing as sexy as a cure for cancer.
This drug isn’t a drug at all- it’s patient engagement.  Studies have shown that patients who are engaged in their care have better outcomes and incur less healthcare costs.

Unfortunately, we’re still having difficulties engaging patients.  Part of the issue could be that most practicing clinicians don’t receive formal training to communicate effectively. Additionally, patients with limited health literacy are less likely to speak up and engage in their care.

In patient engagement, we’ve found a tool that costs nothing and saves lives, and most of its implementation centers around communication.  While it may feel like it takes longer to slow down and communicate effectively, it can help keep patients out of the hospital and save you time in the form of less follow-up calls and visits.  While overall, increased patient engagement will likely come over time with a culture shift from patients and clinicians, we can start by employing a few communication techniques to start:

  1. Use simple language
  2. Use the teach-back method to check for understanding
  3. Focus in the most important information

These three things can go a long way to blockbuster results.

 

 

 

https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2013.0037

https://health.gov/communication/HLActionPlan/pdf/Health_Literacy_Action_Plan.pdf

https://www.youtube.com/watch?v=cGtTZ_vxjyA

Picture of the North Carolina State flag in the shape of the state

NC Medicaid Expansion- A quick look at pros and cons

In North Carolina’s State of the State address Monday night, Governor Roy Cooper encouraged the state legislature to expand Medicaid.  Among other reasons,  he cited that North Carolinians federal tax dollars pay for Medicaid expansion in other states, so our residents should have access to those services as well.  Medicaid expansion has been on many people’s minds since the Affordable Care Act made it possible in 2014.  In honor of this, let’s highlight some of the arguments for and against it in North Carolina.

Against Expansion

For Expansion

These are some of the main pros and cons to Medicaid expansion.  What are some other arguments, both for and against, that you’ve heard?

 

 

 

https://www.facebook.com/ABC11/videos/261495221441061/

http://www.fiscalhealthnc.com/to_expand_or_not_to_expand_the_pros_and_cons_of_medicaid_expansion_in_nc

https://www.newsobserver.com/opinion/article224597675.html

https://www.rwjf.org/en/library/research/2018/05/implications-of-state-medicaid-expansion.html

https://www.ncdp.org/our-values/health-care/

https://www.nejm.org/doi/full/10.1056/NEJMsa1202099

 

 

 

 

 

House made of puzzle pieces with one piece missing

Housing First helps homelessness and saves money

Housing First is catching on across the county with great results. In this model, homeless and housing-unstable individuals are provided with permanent housing before the organization attempts to address other issues like substance use and employment.

The Housing First Model has seven core tenets:
1. There are few if any prerequisites to permanent housing
2. There are few barriers to entry.
3. They allow for rapid entry to housing
4. Supportive services are encouraged but are ultimately voluntary
5. Tenants have full legal rights, responsibilities, and legal protections
6. They include policies, like installment payments for missed rent, that help prevent evictions.
7. This model can be applied in many housing types.

The University of Illinois Hospital started a Housing First modeled program as they a direct connection between housing and health. In November 2015, they committed $250,000 to re-housing their homeless frequent emergency department users. Among the program recipients the hospital has seen a 57% reduction in inpatient stays and a 67% decrease in emergency department utilization since its inception.  This means healthier people and less cost on the already strained medical system.

Though some may find the idea of providing housing without additional stipulations controversial, even our federal government has started endorsing this practice.  On the United States Interagency Council on Homelessness’s website, the first item listed under “solutions” is to deploy a system-wide housing first program. By providing homes without additional barriers, Americans save up to $23,000 per participant compared to the cost of traditional housing programs.

As this model spreads across the country, support it with your votes and actions.  Look for politicians who support this model and want to allocate city funds toward housing first.  Its just one more way we can help our fellow humans.

 

 

 

 

 

https://essentialhospitals.org/quality/qualityfree-housing-helps-homeless-patients-achieve-better-health/

https://www.hudexchange.info/resources/documents/Housing-First-Permanent-Supportive-Housing-Brief.pdf

https://housingforhealth.org/bhh/

https://www.usich.gov/home-together/

http://endhomelessness.org/wp-content/uploads/2016/04/housing-first-fact-sheet.pdf