Harvey, Harvey, Harvey

Hurricane Harvey struck the gulf coast of Texas this weekend and has caused record-breaking, devastating damage throughout southern Texas and Louisiana. Even as it has been downgraded from a Category 4 hurricane, the tropical storm is still raging over the coast causing flooding and destruction in its path. The financial cost of the damage that won’t be fully realized until the aftermath of the storm becomes more apparent, is nothing compared to the potential health costs that will arise in the future days, weeks, and months.

The immediate affects of flooding can be seen all over the news. From drowning, hypothermia, to tragic accidents, such as this boy who was electrocuted while wading through floodwaters.Rising water levels near coastlines can invite wild animals into residential areas. Muddy water can obscure visibility of what if lying below the water, from animals or glass. The most serious consequence to flooding is death. Many people often underestimate the risks of flood waters, even if the level of the water is low or it appears calm. Thus, in addition to the deaths that occur through tragedy, such as the family that was swept away while trying to drive through flood waters, there are also changes to risk behavior as people underestimate the dangers of flooding.

Officials presiding over the areas affected by Hurricane Harvey are concerns about the public health risks created by the flood water in the South. The concern is so great that Health and Human Services Secretary Tom Price declared a public health emergency for the state of Texas over the weekend. The CDC is concerned about the release of chemicals caused by the flooding. Additionally, this morning, there was a chemical plant explosion that led to air contamination that may have affected the staff at the plant and surrounding area, as well as had the potential to release peroxide into the water. Chemicals contaminate flood water when the water washes through houses, garages, stores, factories and other facilities that contain chemical-containing products. Additionally, the floods have overwhelmed sewage drains, trash disposal systems, and have swept garbage from businesses and residences. This further contaminates water with sewage and trash, adding to the chemical composition of the flood waters. The contaminated water then comes into contact with food, clothing and fabrics, and citizens that have not evacuated. The chemicals can cause gastrointestinal symptoms, leading to immediate illness, or even leech into items and cause a long term impact. It is important to note that this water can cause damage to medications and food that is even stored in plastic packaging.

The moisture from the water and the loss of sanitation is an ideal environment for bacteria growth, which may lead to an increase in infections in the coming months. Salmonella, E. coli, pink eye, rashes, and upper respiratory symptoms are all risks of contaminated flood waters. Areas affected by flooding are at particular risk for food borne illnesses. Additionally, the decrease in sanitation in the affected areas can lead to increased risk for tetanus and MRSA. Additionally, there is a risk for outbreaks of parasites. The risk of the spread of these infections is exacerbated by the makeshift housing facilities in the area, as many people are living in shelters after extensive damage to their homes have made them unlivable. The close quarters make fecal-oral transmission of disease much more likely, creating a potential environment for an outbreak. Luckily, cholera and dengue fever are not endemic to the United States so the risk of these diseases are minimized, because the illness would have to be brought in from another location in order to grow or spread in the current conditions.

As the water recedes, there will be mold growth on appliances, toys, hard surfaces, fabric/porous surfaces, and building structures. The increase in mold and mildew can contribute to respiratory infections and further contaminate food and objects.

The standing water can also contribute to the breeding of insects, particularly mosquitos. Mosquitos thrive in wet environments and lay eggs in standing water, creating more mosquitoes. These insects are vectors of diseases and can lead to outbreaks. Notably, they carry Zika, a disease which has been a large concern over the past year for causing microcephaly in babies born to infected mothers. Additionally, after Hurricane Katrina, there was an increase in the number of cases of West Nile Virus.

In addition to the physical damages of the storm, there are still mental health consequences as residents of the affected cities face the potential loss of friends, family members and possessions. Additionally, the need to accept help from others or be dependent on a situation that evacuees feel they cannot control can lead to feelings of helplessness. The stress of being dislocated from their homes or separated from loved-ones can contribute to mental health challenges, including anxiety, depression, or PTSD.

For those of you looking to help in the relief efforts, if you are unable to volunteer your time to organizations such as the Red Cross, there are numerous ways to make monetary donations or contribute physical items to the effort. Please note that following a suggested list is the most helpful way to extend your aid, rather than buying what you feel is the best gift of your own accord. To see donations options, please consider the Red Cross, Save the Children, or the Salvation Army.


Balanced Diets and Fad Foods

Last week, we discussed the obesity epidemic (here). This week we are looking into dietary recommendations made by various organizations to maintain a healthy weight and lifestyle. Guidelines for a healthy diet have changed over the years as research and lifestyles have evolved. Most of us learned about nutrition guidelines in high school health class, so it doesn’t seem unreasonable that 5, 10, or even 15 years later we all might need a refresher or even an update on what recommendations have changed.

To review, it might be helpful to take a moment to reflect on your own eating habits and calculate your BMI (here) so that you have a baseline to reference to when you are looking at the suggestions below. It may surprise you to see how well you are (or are not!) meeting the guidelines in your daily life.

The USDA sponsors a website called “Choose My Plate” that outlines the government’s diet recommendations, including portion sizes, weight management, and education on making healthy food choices. The site outlines the 6 recognized food groups: fruit, vegetables, dairy, protein, grains and oils. A well rounded diet includes foods from all of the categories, but current recommendations no longer give a flat-out portion size. Instead, the recommended portion of each category is determined by your sex and age. For instance, women aged 31-50 years should eat 5 ounces of protein foods a day, whereas men of the same age are recommended to consume 6 ounces. For people who consume little or no meat, the website also has information on alternative ways to meet the protein recommendations, such as consuming beans, peas, nuts, or soy products. The website also has a component called the “Supertracker,” which is designed to help you track your diet and exercise, allowing for a comprehensive analysis of your healthy habits.

Due to the number of changes that have occurred to the dietary recommendations over the years, a number of fad diets have sprung up. Often times these diets are not based entirely on fact or they eliminate a food category entirely, which can lead to bodily harm or yo-yo weight gain and loss. A fad diet is defined as “a diet that promises quick weight loss through an unhealthy and unbalanced diet, often without exercise.” It is important to note that diets that taught quick results for little effort are often deficient in some way and can lead to harm, including anemia, organ damage, vitamin deficiency, or contribute to long term health problems.

While eating a food more frequently does not officially constitute a weight loss diet, or often even a significant change to your current nutritional status, super foods have recently become the latest trend in health and nutrition. These foods often are claimed to have amazing health benefits that were previously unknown or underappreciated, and the support of incorporating these foods into your diet is often founded on some miracle claim. UK’s NHS states that many people who cling to the “powers” of super foods mistakenly believe they can ‘undo’ the damage caused by unhealthy foods by eating a super food. Examples of super foods over the recent years have included blueberries, avocado, pomegranate, green tea, and even chocolate.

One of the recent foods that falls into this category is coconut oil. There have been many health claims linked to the food, probably because of it’s plant base, but it is important to know the nutritional facts about this food. In regards to fats and oils used in cooking, coconut oil is actually middle of the road, health wise. The latest concern with coconut oil is that studies indicate that it raises LDL cholesterol levels. As a reminder, this type is often referred to as the “bad” cholesterol that contributes to heart disease. Unsaturated fats from plant oils are the best type of cooking fat because the fat chains are “kinked” or “bent” because they contain less hydrogen atoms. These fats contain essential fats which are used in cells, tissues, and organ systems, and they also can contain other elements, such as Omega-3 or Omega-6 fatty acids that can prevent heart disease. Coconut oil has more saturated “straight chain” fatty acids than other plant based counterparts, making is a less healthy alternative to things such as olive oil, coconut oil or sunflower oil. (Although it is still a healthier alternative than using lard or butter, which are very high in saturated fats, like all other animal based fats). Thus, although coconut oil is better than some options, it is far from being the miracle alternative some people claim it to be. There are healthier alternatives and long term consequences to consider before converting 100% of your cooking oils or butter replacements with coconut oil products.

Evaluate your own diet and food choices to see how well you align with the current recommendations. The start of a new school year is often a great time of the year for families and students to make small changes to eating habits. Additionally, if you decide to lose weight or make a major overhaul of your food intake, please consult a physician or a dietitian for guidance. They will evaluate your current health and give you personalized recommendations about how to safely lose weight!


Obesity in America

Generally, a healthy weight versus overweight status are determined by calculating a person’s body mass index, or BMI. According to National Heart, Lung, and Blood Institute, “Body mass index (BMI) is a measure of body fat based on height and weight that applies to adult men and women.” A BMI of less than 18.5 is underweight, between 18.5 and 29 is normal weight, and between 25 to 29.9 is considered overweight. A BMI above 30 is considered obese. Obesity is often linked to high calorie diets and low levels of physical activity, a lifestyle likely enforced through industrial development. As our quality of life increases, our surrounding environment makes it easier to access calorie dense foods in large portion sizes for a low price with little work of the consumer. Additionally, the use of cars and a sedentary lifestyle has reduced our energy expenditure as exercise less and use less physical energy to maintain our livelihoods. This all adds up to an increase in energy and a decrease in energy output. The left over energy from this unbalanced system is stored as fat in our bodies.

In America, obesity has become an epidemic as more and more members of our population are above a healthy body weight. According to the CDC, “More than one-third (36.5%) of U.S. adults have obesity.” The prevalence of obesity in our population continues to increase every year, and it affects all ethnic groups, ages, and educational and socioeconomic levels. Despite disparities in the prevalence of the condition among race and socioeconomic status, there is not a single category of people unaffected by our collective weight gaining problem. While carrying extra weight may sound like it is just a matter affecting body image, it is much more than that. Extra body fat is implicated as a contributing factor in a number of different health problems, including heart disease, stroke, type 2 diabetes and even cancer. This is a noteworthy connection because heart disease is one of the leading causes of death in the United States.

Recent studies have been focusing on the composition of a person’s weight by focusing on the volume of body fat a person has, and have noted that even individuals with a healthy BMI can have health risks due to a term called “overfat.” Over fat is used to describe individuals with body fat levels significant enough to pose a health risk. The fat to blame is largely categorized as abdominal fat or belly fat. It is proposed that approximately 76% of the entire world is over fat. This adds another dimension to the already complex area of study that is constantly changing as we learn new things.

A recent study, as detailed by CNN, illustrates the complexity of weight. It revealed that even overweight or obese individuals with normal labs for things like cholesterol, blood pressure, or other metabolic markers are still at a significant risk for developing heart disease. This is an important finding given the increasing trend of “fat but fit” in which individuals who are overweight but still fit in the medically healthy category. It is important to be aware that while they are not at the same risk for heart disease, their risk is still elevated when compared to their normal-weight counterparts, despite their lab work appearing normal, creating a false sense of security. This study highlights the deficiencies of the current measures of health and obesity used in the medical field.


Welcome the New Surgeon General

This week, a new Surgeon General of the United States was named. The man is Dr. Jerome Adams and was President Trump’s nominee for the role. His 4 year term presiding over the U.S. Public Health Service Commissioned Corps, a subdivision within the US Department of Health and Human Services, was approved by Congress. He will also be a part of the National Prevention Council, a department that emphasizes our country’s growing involvement in public health and preventative care. This council primarily focuses on prevention, wellness, and health promotion by utilizing the coordinated efforts of multiple departments. He will take over this post from Rear Adm. Sylvia Trent-Adams who was the Acting Surgeon General after the controversial resignation of Dr.Vivek H. Murthy, who was appointed by the Obama administration.

Prior to taking this position, Dr. Adams served as the state health commissioner for Indiana. He has also worked as an anesthesiologist and assistant professor of Indiana University School of Medicine. Besides having a medical degree, Dr. Adams also has a masters in public health, an education that has helped advise his actions as the state health commissioner. Last year, he notable helped quell an HIV outbreak in Indiana by working with the CDC to establish a needle exchange program in the state. The results have been noted to be a great success but have not reached the root of the problem, which is drug addiction. It has been generally supported that Dr. Adams may have the knowledge and interest in public health necessary to make real, impactful changes in field during his 4 year term.

The new Surgeon General has announced that opioid epidemic, obesity, and issues regarding cost and access to healthcare are his top priorities upon taking the position. His particular focus on the opioid epidemic comes at a most appropriate time as the ongoing, worsening crisis has been urged by many to be declared a public health emergency. In fact, it was noted by the commission that “142 Americans die from drug overdoses every day,” and this figure is a monumental increase from the amounts seen at the start of the millennium. Stories of the impact of this epidemic can be seen littering newspapers and news sites across the country. Examples can be found here, here, and here, to name a few. The stories have even leaked into news centers across the globe, as can be seen in an article published by BBC, a British based news source.

Let us wish Dr.Adams best of luck and informed decision making in his endeavor to reign in the public health issues of our nation. He certainly has large shoes to fill as health care and public health continue to be hot topics of public interest, and the need for definite, firm leadership could not have come at a more opportune moment.

Healthcare Series

So, What is Healthcare? Part 5: Trump Healthcare

After the Affordable Care Act was put into action via the Obama administration, many people were unhappy with the changes that took place. As a result, the drive to change or repeal the new system in favor of other structures gained support. One of the platforms that fueled President Trump’s campaign was the promise to alter the existing healthcare system and undo the changes that were making some of his voters unhappy.

Make note that the plan for the Trump administration and various republican supporters to repeal and replace the Affordable Care Act was seen as a difficult strategy to achieve, even from members within his own camp. As a result, the goal of the administration to change the healthcare system became to simply repeal or alter the current system, as no replacement was widely supported. Additionally, the political requirements to pass such changes were not strongly advocated for amongst the majority, leading amendments and changes to the existing system as the most feasible option. The changes are outlined clearly by CNBC and will be detailed here today.

What changes were proposed to take place in the reported bill to be passed through our legislative branch? According to CNN Money “American Health Care Act goes a long way to fulfilling the Republicans’ seven-year pledge to repeal former President Obama’s landmark health reform law.” The original bill passed in the House of Representatives would have removed the subsidies paid out to enrollees based on their income, a new initiative of the ACA mentioned in last week’s edition of “So, What is Healthcare.” Rather than just ending governmental support of all kinds for enrollees, the plan was to change the support by offering tax credits based on age instead. Additionally, the plan is to remove mandatory enrollment and making health insurance optional. Mandatory coverage was one of the biggest changes instituted by the Affordable Care Act and it has been a hot topic of debate since it’s inception. This would also remove the requirement for businesses to require health coverage to their employees, outsourcing insurance programs or leaving enrollment up to other avenues once again. These changes alter the basis of availability of plans and the requirements for enrollment. Other changes alter the structure of health insurance policies and coverage plans.

The proposal originally set out to allow insurers to offer plans that don’t include all of the elements mandated by the Affordable Care Act. These plans would be limited in the scope of coverage, allowing people to opt out of mental health coverage or maternity care. The idea is that people will have more flexible options when choosing an insurance plan that fits their lifestyle and the potential costs could be kept to a minimum for people who do foresee the need to have comprehensive coverage of these areas of treatment. The flip side of this is that it would make comprehensive coverage harder to access, and there is a potential that coverage could be more limited or less protective for people with pre-existing conditions. This is especially true because the proposed system would allow insurance companies to change their premiums based on pre-existing conditions. Limiting care for people with pre-existing conditions is a direct contradiction to Trumps goals of ensuring access to this population.

The proposed changes would also affect Medicaid by providing set allowances of funding per state. The idea is that this gives states more rights and control of the programs in their state and ideally allows for more resources and flexibility. There would be a per-capita cap limiting the amount of money each state has for the Medicaid program and the amount of money allotted for each enrollee. The concern here is that the shift in funding moves primarily to the individual states that not have the ability to support these programs without adequate federal assistance. This would cause a shortage of funds, leading to changes in requirements for Medicaid enrollment, difficulties in payment or benefit distribution and access, and reduce the amount and quality of care for patients using Medicaid.

2 weeks ago, the Senate was planning on voting on the latest version of he Republican health care bill. The perception of the bill at that time was that it would not have enough support to pass through Senate due to the opposition by democratic representatives and division amongst representatives of the republican party. After a number of delayed votes, the Senate rejected the proposal.

Want to check back on the previous parts of the series? Great! Check them out here: Part 1, Part 2, Part 3, Part 4

Famous Names

Dr. C Walton Lillehei

This month, for the third edition of “Famous Names in Public Health!” I will focus on the medical side of healthcare by recognizing a figure who contributed significantly to the treatment of cardiac conditions. I have been reading “The Heart Healers” by Dr. James Forrester and have loved his story telling manner when describing the history of cardiac surgery, so I decided to choose a notable figure outlined in the story as the focus for this month’s segment. This man is Dr. C. Walton Lillehei, the father of open heart surgery.

In the years leading up to modern open heart surgery techniques, the field underwent many changes. Methods that were used in the 1950s are almost unfathomable by todays standards and ethics. However, it was in this time period that truly innovative (and dangerous) techniques were a long standing component in the quest for successful open heart surgery. Dr.Lillehei primarily focused on the yet-unsolved challenges to treating what were known as “blue babies,” or infants and children born with congenital heart defects that could not be repaired through medical treatment or closed heart surgery. These children often suffered symptoms of their disease without relief and were given the equivalent of a death sentence. While doctors could diagnose the conditions, they could do little to prevent the progression of the disease as structural problems in the heart failed to keep up with the demands of the patient’s growing body. Essentially, many of these children died due to an inability to efficiently pump blood to vital organs.

Dr.Lillehei was a pioneer in the development of heart-lung bypass systems and open heart surgery. In 1954, Dr. Lillehei performed the first successful open heat surgery using cross circulation with the father of the patient as the source of oxygenated blood. This method was used throughout numerous surgeries and put the “donor” at great risk of harm or injury, so the method was quickly abandoned as other forms of blood oxygenation developed. Dr.Lillehei was involved in the progression of open heart surgery methods moving forward. He helped implement the bubble oxygenator, hypothermia techniques, cardiac pacemakers and prosthetic heart valves. While some of these techniques are no longer used and the surgical devices he used have since undergone many changes to increase effectiveness, safety, and efficiency, Dr.Lillehei’s early involvement in cardiac care altered the trajectory of cardiac surgery, launching us into the future of medicine.

His career impacted many patients, medical staff, and physicians alike as he was active in academic and hospital administration positions throughout his career. After working as a surgeon at University of Minnesota Medical School , he served as the chairman of the department of surgery at Cornell University Medical Center and surgeon in chief at New York Hospital. He later returned to the University of Minnesota Medical Center and additionally served as chairman of the American College of Cardiology. The American Heart Association notes Dr.Lillehei’s lasting impact by stating, ” First- and second-generation Lillehei trainees have developed important techniques in transplantation, perfusion, coronary artery bypass, prosthetic valves, and congenital heart surgery.” This recognizes the lasting impact he had on cardiac surgery far beyond his own individual practice, research, and years of surgery.