The Public Health Advocate: Indivisible (Fall 2018)

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6 IS WINTER COMING? ARTIFICIAL INTELLIGENCE IN HEALTHCARE

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PUBLIC HEALTH ADVOCATE

20 PARALYZED BY POLIO

25 UNDOING ILLNESS WITH DEAN ORNISH, MD

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FALL 2018

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PUBLIC HEALTH ADVOCATE A UC BERKELEY UNDERGRADUATE PUBLIC HEALTH JOURNAL FALL 2018 ISSUE

EDITORIAL BOARD EDITORS-IN-CHIEF Brandon Chu Joy Suh PRINT MANAGING EDITORS Erika Kumar Alisha Mehdi ONLINE MANAGING EDITOR Ilhaam Burny EXTERNAL RELATIONS MANAGER Amy Chang DECAL MANAGER Nirali Patel

STAFF

COPY EDITORS Haley Chen Jill Litman Chigozie Maduchukwu Navya Pothamsetty Zoe So Vanessa Tran Iris Xu CONTRIBUTING WRITERS Vivian Bui Navya Pothamsetty Saher Daredia Elise Rio Naomi Epps Rona Wang Jill Litman Julia Weiland Melinda Liu Kelly Woods Shannon O’Hara Amy Zhang

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TABLE OF CONTENTS Getting Excited Over Anxiety 4 Is Winter Coming? Artificial Intelligence in Healthcare 6 The Crisis of Crisis Pregnancy Centers 9 Temple or Therapy? 12 A Hot Debate in California 14 The Latest Buzz: Birds in Berkeley 16 Everything Happens Somewhere 18 Paralyzed by Polio 20 An Uphill Battle 22 Undoing Illness With Dean Ornish, MD 25 The Ugly Side of Beauty Products 28 The Superhumans Behind the Garbage Trucks 30


LETTER FROM THE EDITORS Dear readers, In a time of so much political tension and division, “indivisible” seems to stand for an ideal that so many of us in the United States are struggling to embrace. We are increasingly divided not only between party lines, but also by our beliefs, cultures, practices, and values. And for many across the nation, the past few years have challenged the way we view ourselves and others as Americans. Writing from UC Berkeley, we have seen first-hand that our campus has not been immune to these issues. Even today, many students remember the — literally — explosive protests on campus that took place back in 2017. It is these graphic moments of physical conflict that are ingrained into our memories, making us question the state of our union today. And yet, amidst the seemingly endless conflict and turmoil, amidst some of the darkest moments we’ve faced as a nation this year, we have always come together. Despite our differences, it is our shared vision and desire to build a better future for the next generation that gives us a purpose and fuels our desire to stand united as one. As you read the stories captured within the pages of this

issue, we hope you carry the narratives, perspectives, and information with you beyond the ink and paper of the journal. In “A Hot Debate in California,” Vivian Bui writes about her personal experiences learning about fire suppression policies — and their public health implications — in California. Shannon O’Hara, in “An Uphill Battle,” describes the efforts of three faculty members from universities across California working to stop sexual harassment in academia. All of our writers have taken the time to explore topics they were passionate about addressing, and all of them have highlighted issues that directly or indirectly impact us all. The public health challenges presented through the words and thoughts of our student writers serve as a rallying cry to unite our campus, community, and nation. Only united together can we hope to address, correct, and improve the problems we face today in the hopes of a brighter tomorrow. Because the word “indivisible” shouldn’t stand for an abstract, ideological concept read from the pages of a dictionary. “Indivisible” can — and should — be a reality we wake up to every day. Your advocates,

Brandon Chu and Joy Suh

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GETTING EXCITED OVER ANXIETY Many of us have experienced performance anxiety before. But is telling ourselves to “calm down” the best way to overcome it? BY JULIA WEILAND

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college student is about to take a final for their hardest class of the semester. They walk into the exam room, take a seat, and wait for the test to be passed out, nervously watching the minutes tick by as they fiddle with their number two pencil. The student is filled with anxiety. Sound familiar? Whether it’s a final exam, a work presentation, a singing performance, or anything in between, pre-performance anxiety has plagued every one of us. Research has proven that some anxiety is good. The right amount of anxiety can motivate effort and increase focus. However, too much

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anxiety drains working memory, reduces a person’s ability to process information, lowers self-confidence and increases risk aversion. Yikes! When anxiety goes from helpful to destructive, Dr. Alison Woods Brooks, an assistant professor at Harvard Business School, found that the best way to curb pre-performance anxiety is not what most people would expect. In her study, Brooks asked 300 people what advice they would give to someone with pre-performance anxiety. She found that 84.94% of participants recommended “Try to relax and calm down.” Slogans like “Keep calm

and carry on” or “Calm your nerves” perpetuate the idea that the solution to pre-performance anxiety is to calm down. As it turns out, this method doesn’t work very well. Contrary to popular thought, when your friend recommends you “try to calm down” right before that big exam, you may not want to take the advice. What’s wrong with this seemingly harmless strategy? In Brooks’s study, she discusses the cognitive process required to go from a state of anxiety to a state of calmness. The process is called “reappraisal.” Dr. Iris Mauss, an associate professor of


psychology at UC Berkeley and director of the Emotion and Emotion Regulation Lab on campus, describes reappraisal as “reframing an emotional event in order to modulate one’s experience of negative or positive emotion.” In other words, when a person changes the way they think about a situation in order to change their emotions toward it, they are reappraising their emotions. When someone loses their job, Mauss explains, they might feel their self-esteem is being threatened. Reappraising the situation, however, “could be perceived as an opportunity to transition into a better position.” General consensus has emerged that reappraisal is the most effective strategy for reducing preperformance anxiety. Though the general strategy of reappraisal is the most effective, reappraising anxiety as calmness is not. Why not? While anxiety is a high energy emotion, calmness is a low energy emotion. Due to the fact that anxious and calm emotions “differ in high versus low arousal,” it takes a lot of cognitive and physiological effort to make the switch. Reappraising anxiety as calmness, Brooks explains, “requires a physiological shift from high to low arousal as well as a cognitive shift from negative to positive valence.” In short, because anxiety and calmness are so different, your body has to work extra hard to make the switch from one to the other. Reappraising anxiety as excitement works better. It turns out that anxiety and excitement are physiologically very similar. In fact, it can be hard to tell the difference. If you’ve ever been the victim of a surprise birthday party, you’ve experienced it first-hand. Both anxiety and excitement are high arousal emotions, characterized by an increased heart rate. While the physiological experience of these two emotions is similar, they have incredibly divergent effects on performance. As we have all experienced before, too much anxiety harms performance, but excitement enhances it. People who are excited are more optimistic, focus on the potential positive

outcomes of events, and believe they can achieve more positive outcomes. Brooks says, “Reappraising anxiety as excitement requires only a cognitive change in valence because anxiety and excitement are arousal congruent.” After conducting multiple tests, the results speak for themselves. Brooks conducted studies where she asked people to do all sorts of anxietyinducing activities: public speaking events, karaoke contests, and math performances. In each case, some participants were told to “try to calm down” while others were told to “tell yourself you’re excited.” Participants in the public speaking trial who were instructed to “get excited” were ranked as more persuasive, competent, confident, and persistent. All else being equal, those who reappraised their anxiety as excitement performed better overall in each respective activity. Brooks’s findings demonstrate the profound control people have over their emotions and, thus, over their performance. When a person is feeling anxious pre-performance, repeating a simple phrase like “I’m excited!” or “This is going to be so exciting!” may seem silly. However, studies show that the more we consciously tell our brains something, the more we start to believe it, which actually changes our emotional reaction. As humans, we might prepare for a performance as much as possible and we might take all the right steps. But when it’s performance time, there’s no telling what emotional reaction we will have. Despite our best efforts, it can be hard to control those anxious, negative thoughts from flooding into our brains. What if I fail? What if I’m not enough? What if people don’t like me? While we can’t always control our initial reactions, studies like Brooks’s prove that reappraising those initial reactions can be wildly successful. So, next time you’re about to give that anxiety-inducing presentation, try tricking your brain into thinking you’re excited. The results might just surprise you. 

“BROOKS’S FINDINGS DEMONSTRATE THE PROFOUND CONTROL PEOPLE HAVE OVER THEIR EMOTIONS AND, THUS, OVER THEIR PERFORMANCE.”

ABOUT THE AUTHOR

Julia is a third year intended Public Health major. Before transferring to UC Berkeley this fall, she was a content strategist for Riskalyze, a technology start-up, where she developed their customer education resource. Thus, she is passionate about the intersection of public health and technology, as well as the art of creating engaging content.

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IS WINTER COMING? ARTIFICIAL INTELLIGENCE IN HEALTHCARE Artificial intelligence has revolutionized our lives. In the future, we might count on it to save them, too. BY SAHER DAREDIA

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rom Hephaestus’s creation of mechanical men in ancient Greek myths to Arab inventor AlJazari’s design of the first programmable humanoid robot in the 13th century, the concept of turning inanimate objects into intelligent beings has been a longstanding fascination by humans. While the term “artificial intelligence,” or AI, was not coined until 1956, the seeds of modern AI were first planted by classical philosophers thousands of years ago. The hype surrounding modern AI has not always been constant. Rapid phases of progress have been quickly followed by periods of reduced interest and funding called “AI winters.” Despite the deep historical roots of machine intelligence, the successive combination of the two letters “A” and “I” has the profound ability to elicit polarized responses. On one hand, we hear about artificial intelligence offering practical solutions to a variety of real world problems. Self-driving automobiles to

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tools like Google Translate give us hope of a future where life is even easier and more efficient. Buzzwords like “neural networks” or “predictive analytics” have given rise to multi-billion dollar investments by companies like Google, Amazon, Apple, and Facebook, which are dedicated to further researching and applying these concepts. On the other hand, many people fear a future in which computers take over the world. Regardless of this polarization in opinion, many can agree that AI has revolutionized a multitude of industries. Healthcare is no different. The healthcare sector has been at the forefront of the development of various AI technologies, adopting more and more innovative solutions to improve prevention, diagnosis, treatment, and long-term care. Before we choose to either jump on the AI bandwagon or abandon ship, it is important to consider the facts. AI is centered on the premise

that human beings are not always the most rational creatures. Humans often lack the information and capacity needed to achieve certain favorable outcomes or “success events.” Even though reaching a “success event” is not necessarily guaranteed with machine intelligence, it is guaranteed that the machine has optimized its search for the best strategy towards a solution. In fact, a recent analysis from Accenture, a leading global professional services

“THE HEALTHCARE SECTOR HAS BEEN AT THE FOREFRONT OF THE DEVELOPMENT OF VARIOUS AI TECHNOLOGIES, ADOPTING MORE AND MORE INNOVATIVE SOLUTIONS TO IMPROVE PREVENTION, DIAGNOSIS, TREATMENT, AND LONG-TERM CARE.”


company, considered investments, revenue growth, and acquisitions in the artificial intelligence space. According to their findings, AI applications have the potential to create $150 billion in annual savings for the U.S. healthcare economy by 2026. The landscape of medical problems that can benefit from AI is constantly expanding. Both classical and machine learning AI applications are being used to deliver direct diagnoses of frequent conditions like the flu or distinguish less common conditions that can be mistaken for other conditions. With the use of a branch of machine learning called deep learning, visual recognition software is being used to advance diagnostics within subfields like radiology, pathology, dermatology, and ophthalmology. For example, earlier this year, the FDA approved the IDX-Dr system, the first autonomous diagnostic system that uses medical imaging to detect diabetic retinopathy, a condition when high blood sugar levels damage blood vessels in the retina. Furthermore, these highly accurate diagnoses are available when experts disagree over the interpretation of results, saving resources associated with additional testing. AI is also being increasingly used in prognosis, or the study of the progression of disease based on an individual’s symptoms. Machine learning applications are able to differentiate and focus solely on information that is relevant for tracking particular chronic health conditions, like diabetes and muscular dystrophy. Given several streams of information such as blood pressure and auditory capacity, machine learning is able to identify variables that differ between certain health conditions. By distinguishing what is relevant, AI makes prognosis more efficient and reliable. At The Institute of Cancer Research in London and the University of Edinburgh, a team of scientists are applying these machine learning capabilities towards cancer detection. Researchers have developed a machine learning technique called REVOLVER to make predictions about the evolution of future tumors

ROBOT-ASSISTED SURGERY guided by AI are now being used for a variety of surgical procedures. based on repeating patterns of DNA mutations in existing tumors. With the knowledge gained from this AI tool, personalized interventions can occur at an earlier stage, overriding cancer’s main advantage — unpredictability. In addition to diagnosis and prognosis techniques, artificial intelligence is also being incorporated in the day-today functions of medical practice. By analyzing rapidly growing amounts of patient history data, AI is able to extract clinically relevant information, facilitating the decision-making of health professionals. For example, with consensus algorithms developed by experts and health history data, computers can review and establish treatment alternatives like the most appropriate “cocktail” of chemotherapy drugs. Furthermore, robotic tools controlled by AI have been used for a spectrum of surgical procedures, from tying knots and closing wounds in keyhole surgeries

to removing tumors very close to the sensitive spinal region. According to Forbes, the increased consistency and lower error rate among robotic assisted surgeries has reduced hospital stay lengths by 21%. In fact, a study conducted by Mazor Robotics found that 379 orthopedic surgery patients with AI-assisted robotic procedures had five times fewer complications than regular surgery patients. Some heart surgeons use Heartlander, a mini robot that enters chest incisions to perform heart mapping and surface-level therapy. AI applications help streamline healthcare administrative tasks. Technologies like voice-to-text transcriptions can help order tests, prescribe medications and write chart notes. An example is Nuance, a company that claims to slash the documentation time of health records by 45% and improve reporting quality by 36% through AIpowered solutions. Computer-assisted physician documentation solutions

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TELEMONITORING, facilitated by artificial intelligence, allows doctors to monitor patient status from afar. like Nuance offer guidance during the documentation process through consistent recommendations that facilitate natural workflow. In addition to helping health professionals save time on routine tasks, the automation of administrative tasks ensures that patients receive an accurate clinical history and proper guidance. Artificial intelligence is also applied within telemonitoring, or the remote monitoring of patients that are not at the same location as the health care provider. The Berkeley Telemonitoring Project, one of UC Berkeley’s larger AI research initiatives, has developed a platform for devices that can collect data from a patient, deliver it to a remote server, and automatically analyze it. The analyzed data is then viewable by a healthcare provider, who can promptly offer medical feedback and interventions to the patient. According to Dr. Daniel Aranki, a

“DESPITE THE PROMISE OF AI TO REDEFINE THE NATURE OF HEALTHCARE, IT’S IMPORTANT TO RECOGNIZE THAT EFFICIENCY AND LOWERED OPERATING COSTS ARE PAIRED WITH SOME DIFFICULT REALITIES.” 8 | FALL 2018

researcher in the UC Berkeley Electrical Engineering and Computer Sciences department and the executive director of the Berkeley Telemonitoring Project, the project began by addressing the rate of hospital readmission among Medicare beneficiaries with congestive heart failure. In collaboration with Northwestern Hospital in Chicago, 50 patients with heart failure were monitored for three months and assessed for certain risk factors. “Given the cost, trauma caused for patients, and the sheer amount of people affected by heart failure, any improvement— even by a few percentage points — was considered significant,” Aranki explained. “Telemonitoring warrants a unified framework and that’s why we started the Telemonitoring Project in 2012 to create something more systematic. We started by looking at heart failure and then we ran more studies on other applications like the fitness of marathon runners.” Applications of artificial intelligence in telemonitoring extend beyond projects pioneered by UC Berkeley. Virtual nursing assistants are now becoming available 24/7 to provide quick answers to basic questions and monitor patients, potentially saving the healthcare industry $20 billion annually. For example, San Francisco-based virtual nurse assistant Sensely recently garnered $8 million in funding to

expand and keep patients and health care providers in better communication in between office visits, thereby reducing hospital readmission. Despite the promise of AI to redefine the nature of healthcare, it’s important to recognize that efficiency and lowered operating costs are paired with some difficult realities. The use of AI in healthcare raises ethical questions about who is liable for machine error, inherent biases in the development of AI systems, and the privacy of sensitive medical data. Furthermore, a loss of jobs and human empathy will inevitably accompany additional AI integration in the healthcare sector. It is difficult to foresee whether these concerns will give rise to yet another AI winter, but it is undeniable that AI technologies will disrupt the healthcare system as we know it. According to Aranki, “The machine really has no wisdom. It knows which strategies work better, but it does not know why. You can still learn from it, but you cannot ignore established knowledge gained from thousands of years of studying the human body.” A question remains that only the future can answer — will the wave of artificial intelligence in healthcare stand the test of time and move forward, or will it simply die down? 

ABOUT THE AUTHOR

Saher Daredia is a junior from San Jose, California majoring in Molecular Cell Biology and Public Health with a minor in Global Poverty and Practice. Because of her passion for toxicology research and community-based advocacy, Saher hopes to pursue a career that allows her to use diverse approaches to promote the health of marginalized communities. In her free time, Saher enjoys being outdoors, cuddling with her dog Bolt, and consuming copious amounts of coffee and hummus.


THE CRISIS OF CRISIS PREGNANCY CENTERS Crisis pregancy centers provide pregnant women with free prenatal care. Their goal? To steer pregnant women away from abortion. BY JILL LITMAN

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magine you are a young woman who has just gotten pregnant and is considering an abortion. You are anxious and scared, but you become relieved when you see an ad for a health center that is offering free pregnancy counseling to help you explore your options. However, when you arrive at the health center, you are shamed, misinformed about the risks associated with abortion, and intimidated into continuing your pregnancy. This is a daily occurrence at pro-life pregnancy resource centers, often called “crisis pregnancy centers,” across the country. A recent Supreme Court case has brought the issue of crisis pregnancy centers into the national spotlight. Crisis pregnancy centers are non-governmental organizations that provide counseling, prenatal care, and other services to pregnant women. These centers are typically religiously affiliated and are associated with national anti-abortion organizations. Crisis pregnancy centers aim to convince teenagers and young women with unplanned pregnancies to choose motherhood or adoption rather

than receive an abortion. Though these efforts may seem well-intentioned, these centers often use deceptive advertising, provide inaccurate medical information, and disproportionately target women of minority and lowerincome backgrounds. In June 2018, the Supreme Court ruled that crisis pregnancy centers are not required to provide pregnant women with information about how to end their pregnancies. The case, National Institute of Family and Life Advocates v. Becerra, was concerned with a California law that requires crisis pregnancy centers to post notices informing low-income women that free or low-cost abortion, contraception, and prenatal care are available to them through public programs and to provide contact information for these resources. The centers argued that requiring these notices was essentially mandating that they promote the practice of abortion and was a violation of their right to free speech. However, those defending the law argued that the notices counteracted the often incomplete or misleading

information provided to the women by the clinics themselves. Although much of the debate surrounding the Supreme Court case has focused on how the court should analyze First Amendment challenges, the case has drawn attention to how crisis pregnancy centers that disseminate incorrect or misleading information regarding abortions pose a significant public health risk. These centers often advertise services, such as ultrasound and STD testing, in high school and college newspapers, on buses, and billboards. A Google search using phrases such as “abortion services near me” often returns a list of results with crisis pregnancy centers featured prominently at the top of the list. For these reasons, many women will seek care and medical counseling at a crisis pregnancy center despite the fact that most centers do not have medically trained or licensed staff members. For example, according to a 2007 survey conducted by NARAL ProChoice Maryland, only 18% of Maryland crisis pregnancy centers employed trained medical staff.

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Crisis pregnancy centers often disseminate misleading information about the potential risks associated with abortion. According to the Guttmacher Institute, some crisis pregnancy centers tell women that abortion increases their risk for breast cancer and of having a future ectopic pregnancy. Centers also made claims that it makes future conception difficult, causes severe scarring and damage to the uterus, and will negatively impact their mental

“BECAUSE THESE CENTERS DO NOT PERFORM ABORTIONS, THEY ARE NOT BOUND TO THE LEGAL, ETHICAL, AND MEDICAL STANDARDS OF INFORMED CONSENT.”

health. However, all of these claims are either misleading or downright false. Numerous studies conducted by the National Cancer Institute have concluded that there is no association between induced abortion and increased breast cancer risks. Additionally, while problems like uterine scarring, ectopic pregnancy, and infertility have been observed from second-trimester abortions, first-trimester abortions, which comprise 92% of all abortions performed in the United States, are not associated with any of those outcomes. Providing misinformation about the risks associated with abortion aligns with crisis pregnancy centers’ goals to discourage women with unplanned pregnancies from seeking abortions. Because these centers do not perform abortions, they are not bound to the legal, ethical, and medical standards

of informed consent. Regardless, the misleading information they provide has influence over whether a pregnant woman chooses to terminate her pregnancy, and this is clearly too important a decision to make based off of incorrect information. Ultimately, the misleading information provided by these centers poses a significant public health risk because it may pressure women who are not suited for parenthood at the time they conceive to have an unintended birth. There are multiple factors at play that can influence a woman’s decision to take on the responsibilities that come with raising a child such as her age, financial situation, or substance dependency. Several negative outcomes resulting from having an unwanted pregnancy have been documented. According to the Institute of Medicine’s Committee

CRISIS PREGNANCY CENTERS, like the one pictured above, often advertise free services like testing and counseling. However, the information they provide can be misleading — or even false. EDITED / ORIGINAL PHOTO BY BRIANNE BILYEU 10 | FALL 2018


on Unintended Pregnancy, women with unintended pregnancies are more likely than others to seek prenatal care later in their pregnancy or receive no prenatal care at all. They are also more likely to use tobacco and alcohol during pregnancy, continue to smoke after giving birth, suffer from postpartum depression, deliver prematurely, and not breastfeed. Their children are more likely than others to have a low birth weight and an increased risk for negative physical and mental health problems. Crisis pregnancy centers also disproportionately affect women who are young, uneducated, and impoverished, the same groups that have the highest unintended pregnancy rates in the United States. Research published in the New England Journal of Medicine has shown that the rate of unintended pregnancies is higher among U.S. women aged 18 to 24 than among those of any other age group and is three times higher among women who have not completed high school than it is among college graduates. These vulnerable populations are most likely to be drawn to crisis pregnancy centers for their advertisement of free health services, such ultrasound, STD, and pregnancy testing. Women who seek care at crisis pregnancy centers often do so later on in their pregnancy than those seeking care elsewhere. This is because younger, less educated, and poorer women take longer on average than older, better educated, and higher income women to confirm a pregnancy once they notice warning symptoms. As a result, women who seek care at crisis pregnancy centers are likely to be further along in their pregnancies than women who seek abortions elsewhere. In the case that they have already affirmed their decision to end their pregnancy, they need an immediate referral to a facility that offers such abortion services. Crisis pregnancy centers will often take advantage of women in this vulnerable situation by persuading women to postpone their abortion, often telling women that it is too early in their pregnancy to have one or falsely reassuring them that they

can still obtain one as late as their third trimester. For example, the website for Valley Crisis Pregnancy Center located in Pleasanton, California, encourages women to delay their abortions by emphasizing that miscarriage is an alternative to getting an abortion. On their website, it reads, “Since up to 24% of all pregnancies end in a natural miscarriage, it is important to ensure you are not considering a procedure that may not be necessary.” Crisis pregnancy centers will often use deceptive tactics to convince women to postpone their decision until they are far along enough in their pregnancy that they are no longer legally eligible to obtain an abortion. By removing the requirement for crisis pregnancy centers to inform women about the reproductive services that are available to them, the recent Supreme Court ruling jeopardizes women’s ability to access the healthcare that they need. Dr. Kristin Luker, the co-founder and faculty director emerita of the Center of Reproductive Rights and Justice at Berkeley Law, believes the Supreme Court ruling, as well as future legislation concerning reproductive rights, has the potential to have a large impact, especially on marginalized populations. “I really think that there is something, both genius and wicked, about what I perceive to be the strategy. They are not going to outlaw abortion directly, because of the massive political fallout,” she said. Instead, Luker believes that this ruling is yet another step in a political agenda that aims to increase the barriers to reproductive healthcare access. “What we’re going to see is a strategy which is going to continue to make it harder for women to get abortions. We’re going to see a strategy that is going to fall the hardest on young people, poor people, and people of color. These are the people least likely to mobilize.” The current debate surrounding the intersection of reproductive rights and free speech has many worried about future legislation surrounding these issues. It should be made clear

“CRISIS PREGNANCY CENTERS ALSO DISPROPORTIONATELY AFFECT WOMEN WHO ARE YOUNG, UNEDUCATED, AND IMPOVERISHED, THE SAME GROUPS THAT HAVE THE HIGHEST UNINTENDED PREGNANCY RATES IN THE UNITED STATES.” that crisis pregnancy centers have, and will continue to have, the right to provide counseling with a prolife agenda. However, these centers routinely target women at vulnerable times of their lives by shaming them, providing false medical information, delaying and inhibiting women’s’ access to contraceptives and reproductive health services, and potentially putting the mother and her child at risk of the consequences associated with having an unintended birth. Crisis pregnancy centers pose a threat to the health of pregnant women and their children and should be approached not as a First Amendment battle, but as a public health crisis. 

ABOUT THE AUTHOR

Jill Litman is a second-year intended Public Health major who has a passion for women’s reproductive health. In addition to writing for PHA, she enjoys acting and directing in Theatre for Charity, helping promote menstrual equity with the Bay Area chapter of Happy Period, and organizing political discussion events for UC Berkeley’s Bridge USA chapter. In her free time, she enjoys performing with her Rocky Horror cast and playing Uno with her housemates.

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TEMPLE OR THERAPY? Asian American and Pacific Islander communities often lack the resources or education to address mental health needs. How do cultural practices perpetuate this disparity? BY MELINDA LIU

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espite a growing awareness and acceptance of mental health issues in America, the Asian American and Pacific Islander (AAPI) community still has progress to make in comparison to other demographics. The AAPI community is extremely diverse, containing more than 43 different ethnic subgroups who cumulatively speak more than 100 languages and dialects. Studies have shown that while more white Americans suffer from mental illness, greater numbers of AsianAmericans lack the resources and knowledge to address their struggles. For instance, 2014 statistics from the Mental Health Bureau and the United States Census show that suicide rates are higher in both younger — 5.3% in Asians versus 4.0% in whites — and older female Asians — 4.8% in Asians versus 4.5% in whites — with mental illness when compared to white female counterparts of the same age. Two key factors perpetuating this disparity are cultural barriers that discourage people from seeking professional treatment and logistical obstacles to receiving mental health care. In the AAPI community, especially among older generations, traditional and religious beliefs dissuade individuals from receiving necessary professional treatment. For instance, Chinese traditions consider mental illness as a lack of emotional harmony within an individual caused by evil bodily spirits. Instead of seeking psychiatry or therapy, family members will rush to recommend traditional herbal medicines to their afflicted loved ones. Broadly, many AAPI cultures believe that depression is merely sadness, so they rely on their loved ones to cheer them up. They view depression as a “mood” rather than a chronic, debilitating condition that necessitates professional help. While Western countries like the U.S. are moving away from the depressionas-sadness view, this perspective is still rooted in the AAPI community. Discussing one’s mental health concerns in the AAPI community is generally taboo. This, combined with mistaken

belief systems regarding mental illness, prevent the AAPI community from getting necessary mental health care. Additionally, Asians value being selfreliant and less open about personal matters. Cultural practices normalize divulging what they are truly going through to close family and friends, which further decreases the chance that they will seek appropriate professional help. Besides cultural barriers to access, there are additional language and logistical obstacles that prevent AAPI individuals from getting mental health treatment. Many older Asians and immigrants do not know English very well, so visiting a therapist who only speaks English would be a significant barrier to effective communication. Moreover, therapy can be expensive, especially without health insurance. The average session costs anywhere between $75 to $150. In fact, before the Affordable Care Act, 15% of Asians lacked health insurance, according to a 2014 study completed by the Mental Health Bureau. The disproportionate amount of suicides and other manifestations of untreated mental health illness suggest that there is a negative stigma around those mental health conditions in the AAPI community. Additional language and financial barriers also prevent them from obtaining the treatment they need for those concerns. As readers, be advocates for mental health. Remain vocal about mental health concerns. Push for more representation; have multilingual professionals speak to AAPI communities to bring an objective, scientific view to mental illness, entirely free of religious or cultural bias. Finally, be open to talking about mental health with fellow community members. Changing cultural norms may take time, but it’s time to give mental health the attention it deserves. 

“MANY AAPI CULTURES BELIEVE THAT DEPRESSION IS MERELY SADNESS, SO THEY RELY ON THEIR LOVED ONES TO CHEER THEM UP.”

ABOUT THE AUTHOR

Melinda Liu hopes to double major in Public Health and Psychology. She’s involved in teaching Chemistry 1A and a DeCal and Party Safe at Cal. When she’s not drowning in homework, midterms, and finals, she enjoys swimming, getting boba, and spending time with friends.

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A HOT DEBATE IN CALIFORNIA Wildfires endanger lives, destroy property, and uproot entire communities. Suppressing them, however, might make future ones even worse. BY VIVIAN BUI

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ince 1992, my family lived in the residential Foothill Ranch, Orange County, situated in the foothills of the Silverado. Our house was in the corner of the quiet cul de sac, which was representative of the calm suburban neighborhood. The 1999 Silverado wildfire sparked a sudden contrast. It wreaked havoc, stirring flames from the other side of the hill and ending only several blocks away from our house. With firetrucks and emergency management situated on our end of the street, my parents took the extra precaution by staying in another city for the weekend. They were worried that the smoke pollution might interfere with my first trimester development in my mother’s womb. However, soon after I was born, the extra precaution didn’t do much to help. More fires started burning near our house. And

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eventually, I began exhibiting symptoms of asthma. Whether the correlation between my asthma and the fires is true science or fictious myth is still in question. All I know for certain is that I grew up terrified of fires. My instinctual response to any news of fire is to extinguish it immediately. Similarly, there is a negative public perception of wildfires, especially now with 2018’s rampant fire season. According to Charles McDermid from the New York Times, this season held the most destructive fire season in California history, driven by cyclic drought, climate change, and population of fire-prone areas. Undeniably, this wildfire smoke poses a public health danger to vulnerable communities. And yet, California’s exclusionary stance and action in fire response poses an

even more consequential public health danger.

Danger to Vulnerable Groups Firstly, fire smoke does accumulate health problems within sensitive groups. Wildfires are an unpredictable component of PM2.5 pollution in California, contributing as low as 17,068 tons in 2005 and 53,487 tons in 2011 to as high as 529,821 tons in 2008. According to a 2008 California wildfire study studying the health impact of exposure, that year’s emissions represented 68% of all PM2.5 emissions in the state. Children, elderly individuals, and pregnant women have higher risks of smoke-related respiratory illnesses and morbidities, such as asthma and chronic obstructive pulmonary disease, due to fire’s fine particulate matter. Similarly, those with cardiac problems are more


susceptible to heart attacks, strokes, and death due to fire’s toxic smoke. As discussed in the research article “Health Impacts of Wildfires,” the scope of the public health impacts goes beyond particulate pollutants, including ozone pollution, increased stress during and after wildfires, and strains on medical services and communication systems. Although these posed various health risks have left the general public scared, anxious, and wanting thorough fire suppression, this isn’t necessarily the best solution.

Making It Worse Fire isn’t necessarily an all-evil entity. Although we may be driven by fear, opting towards fire exclusion policies is not the answer. As discussed by the U.S. Environmental Protection Agency, past practices of extinguishing every fire have been leading to larger, more intense, and more frequent wildfires that threaten life, safety, and property. In fact, the fires in controlled burning practices, such as prescribed or patchwork burning, serve as important landscape management tools that decrease hazardous risks to communities. On the pure Earth’s natural landscape, fires should safely and frequently burn at a low-severity, regulating hazardous fuel loads. The ignitions in prescribed burning aim to mimic Earth’s natural tendencies of reducing fuel loads near developed areas. However, California’s solution of wildfire suppression creates a shift towards infrequent high-severity burns, exacerbating instances of uncontrolled fire. Because the impact and likelihood

“THE FIRES IN CONTROLLED BURNING PRACTICES, SUCH AS PRESCRIBED OR PATCHWORK BURNING, SERVE AS IMPORTANT LANDSCAPE MANAGEMENT TOOLS THAT DECREASE HAZARDOUS RISKS TO COMMUNITIES.”

of smoke increase the longer that fire is kept out of the system, extensive fire suppression can result in a vicious cycle that becomes more and more costly to escape until the system fails, as represented by extreme wildfires. According to a 2009 study, policies that excluded fires for much of the 20th century resulted in an increase in both hazardous fuels and fires for forests in the Western United States.

Taking Into Account All Sides The main issue is that we haven’t differentiated between planned and unplanned fires. Unplanned fires pose threats to public health in terms of air quality, firefighters, general public, and property safety. On the other hand, planned fires are used to manage the impacts of smoke, controlling the amount of fuel burned and always abiding by state air quality regulations, says the U.S. Department of Agriculture. Dr. Kent Lightfoot from UC Berkeley’s Department of Anthropology understands both sides. “The smoke is certainly a public health issue if you’re downwind — but the issue is what happens when you have these major unplanned fires,” he said. “When you’re dealing with public health, there are always pros and cons to whatever you do. In this case, the issue is do they outweigh the ability and costs.” Location is another factor. “There are situations where you’re near urban centers and you’re right next to a residential area,” Lightfoot said. “One, you don’t want the fire to escape. Two, the public health issues, the smoke coming in, might be a real concern. But you have to weigh that idea with the concern that these major major fires take place and all sorts of pollutants come.” It’s this balance of addressing both forest restoration and air quality while taking into account the pros and cons that makes the fire debate so difficult. However, what we are doing wrong could not be any clearer. Yes, it was certainly difficult for me to realize that not all fires are harmful, especially since I grew up believing wildfires had induced my asthma.

PRESCRIBED BURNS are often overseen by personnel, ensuring that fires doen’t escape the intended areas. Although the public has overgeneralized all fires as harmful, the truth is some fires have benefits. The solution to reducing fire hazards to human populations centers isn’t simply a universal fireexclusion policy; the solution is finding a balance. Admittedly, prescribed burning and other purposeful, regulated fires need to overcome the liabilities, issues, and regulations with health standards before global practices. Until then, we must keep an open mind and not allow our fear-driven perceptions of fire to blind us from the scientific facts. 

ABOUT THE AUTHOR

Vivian Bui is a freshman, intending to double major in Public Health and Molecular and Cell Biology. In her free time, she loves learning about the human body, trolling her hallmates, and watching inspirational videos. Vivian hopes to attend medical school and influence public policy in the future.

THE PUBLIC HEALTH ADVOCATE | 15


THE LATEST BUZZ: BIRDS IN BERKELEY Electric scooters are becoming commonplace in Berkeley. What does this mean for city residents and college students? BY KELLY WOODS

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rom public bikes to electric scooters, startups and developing companies are constantly looking for the next hot trend to catch the public eye. Companies such as Bird and Lime have developed electric scooters

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coordinated by an app on a smartphone that provide a cheap, quick, and easy way to get from point A to point B. Birds have made their way to nearly every major city and college in California thus far. After expanding to 75 cities

across the U.S., the electric scooters are found bustling down international streets in Paris or Tel Aviv. They have reached over 20 colleges, including SDSU, UCLA, Point Loma Nazarene, and more. Berkeley is now sandwiched


between cities where Bird scooters are commonplace, such as Piedmont, Oakland, Alameda, San Francisco, and San Jose, so it is only natural that some Birds have flooded the streets of Berkeley. These electric scooters have gained traction for solving the “last mile” problem in transportation; it gets commuters those last couple blocks — from the bus, BART, or Caltrain station — to their desired destination. This issue is especially prevalent with students on college campuses, as scooters can help carry them across campus where Uber would not be able to. According to Bird, 40% of Uber trips are under 2 miles, so this cheap and convenient alternative reduces the traffic and expenses of using Uber for as little as $0.15 per minute. Beyond solving this transportation crisis, electric scooters are environmentally efficient. “Automobile use is the No. 1 contributor to greenhouse gas emissions and climate change. Bike [and scooter] sharing directly addresses this dire situation by offering residents another mode of transportation that is not an automobile,” said City of Berkeley Communications Director Matthai Chakko. “So, by getting more people to bike [and scooter], modes can begin to shift from auto to more sustainable modes, bettering air quality, curbing climate change, raising the public health by folks being active and a host of other goods.” Studies published in The Lancet argue that “outdoor air pollution contributed more than 3% of the annual disabilityadjusted life years lost in the 2010 Global Burden of Disease comparative risk assessment.” There is an abundance of data that holds outdoor air pollution, especially that caused by traffic-related air pollution, responsible for not only for aggravating pre-existing asthma, but also causing new-onset asthma as well. Taking advantage of alternatives other than automobiles is an active choice consumers can make to decrease the traffic-related air pollution footprint of their community. As emphasized by CEO and founder of Bird, Travis

VanderZanden, “Our mission is really to help reduce car trips, traffic and carbon emissions. We think Bird is having a very positive impact in the cities we’re operating in.” Earlier this year, Bird put out a “Save Our Sidewalks Pledge” to ensure that these scooters are used in a way that prevents safety hazards to the community. The company has developed daily pickup programs, placed limits on the growth of scooters, and pledged to donate $1 a day to city governments in an effort to build and maintain safe city shared infrastructure. So what’s the harm in getting a cheap ride to school and having a little fun while you’re at it? The biggest dangers are that the scooters can reach speeds of up to 15 mph, and riders often don’t wear helmets. In the safety section of the Bird app, however, free helmets are offered to all riders who pay for shipping. Others complain of the nuisance that these scooters cause when they are left in sidewalks and other places inconvenient for pedestrians, a problem Bird’s new Save Our Sidewalks pledge aims to address. In fact, in order to ride, you must not only have a valid driver’s license but also be over 18 years of age so that you fully understand the rules of the road. Although some perceive scooters as a threat to community safety, Chakko notes that it’s premature to consider scooters to be a public health hazard. “At the end of the day, the scooterrelated injury reports pale in comparison to automobile collision injuries,” said Chakko. “So while we still address negligent scooter behavior and seek ways to make all people using the public right-of-way safer, we should not be more discerning of scooters over other statistically more threatening modes of transportation.” The City of Berkeley recognizes that these scooters have made their way across city borders, whether they are permitted or not. Scooter companies are required to make a Franchise Agreement with the city to technically be permitted, but the City of Berkeley is already in the process of developing a pilot program

“TAKING ADVANTAGE OF ALTERNATIVES OTHER THAN AUTOMOBILES IS AN ACTIVE CHOICE CONSUMERS CAN MAKE TO DECREASE THE TRAFFIC-RELATED AIR POLLUTION FOOTPRINT OF THEIR COMMUNITY.” with scooter share companies to test their functionality within the city. And although UC Berkeley’s campus has Walk Zones around Sproul, Dwinelle, and Sather Gate, as well as speed restrictions, the City of Berkeley remarked that the popularity of scooters as a method of transportation will most likely soar on campus once measures are taken to regulate these scooters. City employees and UC Berkeley staff are looking at ways to protect public safety and prevent a public health hazard. 

ABOUT THE AUTHOR

Kelly Woods is a sophomore intended Public Health major. She shadows Dr. Banerjee in Primary Care at Kaiser and volunteers as a mentor at a local middle school every week. In her free time, Kelly enjoys camping, concerts, and exploring San Francisco.

THE PUBLIC HEALTH ADVOCATE | 17


EVERYTHING HAPPENS SOMEWHERE

An individual’s location can impact their access to resources. Geographic information systems use this fact to assess health risks across regions. BY NAVYA POTHAMSETTY

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f citizens don’t demand evidencebased decisions from their political leaders,” says Dr. Charlotte Smith from UC Berkeley’s School of Public Health, “those leaders have no incentive to create policy based on facts.” By the very nature of their scope, public health initiatives involve large-scale decision-making. Policymakers are often forced to make determinations not on individual anecdotes and circumstances, but on general population trends. However, legislation aiming to improve society doesn’t always mean that individual citizens have equal access to these benefits. Access to safe, clean, and public drinking water across Berkeley is one such example. Partnering with former City Councilmember Laurie Capitelli, Smith is setting out to assess the availability of public water fountains throughout the City. Berkeley’s soda tax levies an additional charge on sweetened beverages, from Coca-Cola products to sugary energy drinks such as Gatorade. The idea behind

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the extra charge on these beverages is that it would incentivize consumers to drink water rather than a sugar-filled

drink. While this seems ideal in theory, such regressive taxes disproportionately

IMAGE COURTESY OF CHARLOTTE SMITH

WATER FOUNTAIN CLEANLINESS, as well as 10 other variables like functionality and accessibility, was mapped using GIS. Students in Smith’s class collected data from 23 inventory zones inside Berkeley city limits.


A MOBILE APP was used by project team students in the class Public Health 170C to collect data. This included the photographs and exact locations of water fountains around Berkeley. IMAGES COURTESY OF CHARLOTTE SMITH

affect people who don’t have access to an alternative choice — in this case, clean water. Even after the tax was implemented, Capitelli found that people were still purchasing unhealthy drinks instead of using water fountains. While discussing the problem with Smith, Capitelli mentioned that there was no existing map of water fountains in the area. This led Smith to suggest that her class create a database cataloging the location and condition of public water fountains in Berkeley using GIS, or geographic information systems. The outcome of this project is detailed in a research paper published by Smith and co-author Dylan Avery in BMC Public Health this past year. While a lot can be learned from the initiative itself, there are some underlying lessons in the approach used by Smith and her class that citizens, not just students, can use to build an advocacy platform to make changes within community health. Our communities deserve an administration that studies the facts of environmental health and understands how government policies can directly affect real people, not just abstract constituents. Although this seems like a daunting task for any individual, using a method like GIS, which can help us identify broad trends, is a great way to start identifying community-wide patterns. As with any tool, GIS can be used positively or negatively. While crowd-

sourcing data from the community seems like a great way to elicit active participation from citizens, we have to be careful that nobody, intentionally or accidentally, misrepresents the data. In addition to public health professionals who can use GIS to aid community groups, there are free online tutorials available on platforms such as Esri. Smith maintains that increasing numbers of elementary through high school students across the country are learning GIS in the classroom, indicating that it could soon be as prevalent an educational tool as Microsoft Word or Excel. “Everything happens somewhere,” reminds Smith. We miss a large piece of the puzzle if we exclude location from our calculations. Location simultaneously enables and restricts us: Even in the 21st century, we are limited by where we live, as it determines what we have access to. Most public health problems revolve around access, so combining this knowledge with an analysis of patterns and trends is a good place to identify problems in the community. As Berkeley students, we have amazing tools at our disposal, from state-of-the-art software down to the smartphones in our pockets, which is how Smith’s students collected their data. It is necessary to know how to use these tools, but it is more important that we know why. Understanding how we fit into the larger community enables us to

“LOCATION SIMULTANEOUSLY ENABLES AND RESTRICTS US: EVEN IN THE 21ST CENTURY, WE ARE LIMITED BY WHERE WE LIVE, AS IT DETERMINES WHAT WE HAVE ACCESS TO.” understand the relationships between broad trends and individual people. And that is what public health is all about. 

ABOUT THE AUTHOR

Navya is a third-year majoring in Public Health. She enjoys matcha, traveling, and meeting dogs. At Berkeley she loves teaching with Peer Health Exchange and facilitating Health Service Internship discussions, and working as a research assistant at the Interdisciplinary Center For Healthy Workplaces.

THE PUBLIC HEALTH ADVOCATE | 19


A SOMALI CHILD receives a polio vaccine in this photo taken in 1993. Despite significant efforts in polio eradication, the number of polio cases has stagnated since 1988.

PARALYZED BY POLIO Vaccination efforts have led to significant reductions in the number of polio cases worldwide. But why is poliomyelitis so difficult to eradicate? BY RONA WANG

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odern medicine has mitigated the suffering caused by so many diseases from humankind, yet only one has ever been eradicated. Are we close to eradicating another? The short answer is yes, but the long answer is more complicated. Smallpox was successfully eradicated in 1978, and the next disease on track for eradication is poliomyelitis, or polio. One can draw many similarities between the two: both are viruses that have terrible pathologies, but both are preventable by vaccines that confer immunity to the vaccinated. The reasons for choosing polio as the next target for eradication are various. Take measles, example. Measles is one of the most highly infectious diseases known to man, and it, too, has an effective vaccine. And, unlike polio,

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measles has no known non-human reservoir, meaning measles can’t circulate in non-living media or in nonhuman animals. But, measles complications happen at far lower rates than polio complications, and fear is a powerful driving force. The regular outbreaks and consequent paralysis of thousands of children in the 1950s, together with the dramatic initial success of the oral polio vaccine, convinced the world to set its sights on polio. Globally, the number of polio cases has dropped by 99.9% since 1988 — the last case of polio in the U.S. occurred in 1979 — but it continues to afflict people in Africa and Asia. The World Health Organization (WHO) continues to track polio cases worldwide but the number of cases of the disease has flatlined at

1988 levels. Dr. Arthur Reingold, the associate dean for research at the UC Berkeley School of Public Health who has worked on several vaccine-preventable disease panels worldwide — including those under the Centers for Disease Control and Prevention and the WHO — weighed in on the plateaued eradication efforts. According to Reingold, funding for the WHO is limited overall. With only a few key donors, who are partners on the board of the Global Polio Eradication Initiative already, and several major obstacles preventing vaccination campaigns, polio elimination efforts are stagnating — it’s post-polio syndrome on the scale of countries and international non-governmental organizations. Shortage of funds contributes to the


issues facing vaccination rates. Typical vaccines use an inactivated form of the virus they immunize against; however, the oral polio vaccine (OPV) — the type historically used in most widespread vaccination programs — utilizes a live but weakened, or attenuated, form of the polio virus. The benefit to using an attenuated virus is that it engages a stronger adaptive immune response, which helps long-term immune memory recognize poliovirus should it be encountered in the wild. Those vaccinated with the OPV also shed the live attenuated virus, spreading contact immunity to unvaccinated individuals via the same pathway that people would otherwise be infected, like drinking water in the absence of sanitation. The disadvantage, says Reingold, is that children must be inoculated more than four times in order to establish immunity. Within those doses hides the small chance that the weakened virus reverts to a neurovirulent form and, once shed by a vaccinated person, infects an unvaccinated person with vaccinederived poliovirus. Because of this threat, affluent countries have switched back to the inactivated poliovirus vaccine (IPV), which, according to Reingold, costs around 10 times as much as the oral polio vaccine; the IPV requires more highlytrained vaccinators to administer. IPV pre-dates the OPV and poses none of the risks for neurovirulence because it contains a “killed” poliovirus that is unable to replicate once in the body. Yet the stability of the inactivated virus also has its drawbacks. Although the vaccine prevents paralysis in an infected person, it does not stop that person from transmitting wild poliovirus if they are an asymptomatic carrier. IPV is therefore unable to eradicate polio. As of 2016, Pakistan and Afghanistan were the only two countries where wild poliovirus circulated endemically; for comparison, in 1988, these two countries only accounted for around 0.02% of the global polio burden. Permanent vaccination teams were established in Afghanistan in order to keep children

“POLIO DROPS” ­— ­ oral polio vaccine — are given to a child during a vaccination campaign in Egypt. up-to-date on vaccinations, wherever they were in the country. In spite of such progress, notably an exhaustive effort to eliminate polio in India, some pockets of the world remain hostile. Conflict-torn areas in Pakistan are outright dangerous for vaccine workers to penetrate. Domestic vaccine workers who speak the language and are familiar with the customs have been killed by non-governmental militants, who espouse claims that the OPV is dangerous or that vaccination campaigns are part of a Western conspiracy to sterilize Muslims and prevent children from getting vaccinated. In Somalia, extremist rebels say the vaccine causes AIDS. Other times, it is simply “vaccination fatigue” by parents whose children have received more than 15 doses. So, what can we do? Develop a skill set, says Reingold. Study public health, public policy, or economics, and strengthen political will to work through the problems financing or implementing such complex campaigns. “There are some who say we shouldn’t have an undergraduate major in public health, that undergrads should study things like molecular biology and leave research and field experience to the graduate or medical students,” says Reingold. But at Berkeley, an interdisciplinary undergraduate education helps to develop public

health interests in future doctors and policymakers alike. “‘How does this apply to the real world?’ is a question we ask ourselves a lot here in the School of Public Health.” We are positioned in a place of great opportunity and vast intellectual resources to be solving the toughest global health challenges of humankind. More than 40 years ago, countries around the world came together to rid humanity of smallpox — a global campaign now considered one of humanity’s greatest achievements. With the eradication of polio so attainably close, it’s important, now more than ever, that we not be paralyzed into inaction. Let’s get moving. 

ABOUT THE AUTHOR

Rona Wang is a junior intending to declare in Public Health. She has diverse interests including infectious disease microbiology and epidemiology, sociological influences on healthcare access, and engineering design. In her free time, Rona reads science news, goes to far more shows than her wallet can afford, and plays card and board games with her friends.

THE PUBLIC HEALTH ADVOCATE | 21


AN UPHILL BATTLE Sexual harassment occurs in universities — on the faculty level, too. Here are the women fighting to end it. BY SHANNON O’HARA

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n the words of Dr. Dawn Sumner, a biogeologist at UC Davis, one of the first things we can do to combat sexual harassment is to talk about it more. For Sumner, this meant writing a letter. “Sexual harassment has been an unfortunately common occurrence within academia for its entire history, often without consequences for the perpetrators,” Sumner writes in the letter addressed to the UC Davis Department of Earth and Planetary Sciences, of which Sumner formerly served as chair. “Reducing the likelihood of sexual harassment starts by building a local community of trust, respect, and openness.” Sumner’s letter continues on, encouraging both survivors and witnesses to report their experiences in whatever way they feel most comfortable. By avoiding difficult,

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painful, and controversial conversations, she argues, the community is limited in its ability to improve. In one of the final paragraphs, she recalls a particular time she personally experienced “significant sexual harassment” while working at a field site. The incident took place on the other side of the world, on the frigid slopes of Antarctica. In an interview, she alleges that she was groped by a Russian

DAWN SUMNER is a biogeologist at UC Davis. This photo was taken on one of Sumner’s scientific expeditions into the Pearse Valley in Antarctica. Sumner works to support other universities in taking clear stances against harassment in the workplace. PHOTO BY DAWN SUMNER

scientist while working on a privately funded field project. Sumner reported the incident to a trusted colleague, but he was unable to help her. She was in her early 40s, living in a time period when reports of sexual harassment were not always regarded with the seriousness and gravity that they are today . “That sent me into a bad mental place, even though I’m a super strong person,” explained Sumner. “Given my strength when it actually happened and


how badly it hit me — that has increased my passion for being there to … help prepare people with resources and techniques to protect themselves and prevent harassment before it happens.” Workplace harassment can occur in any occupational setting, but there are certain aspects of the fieldwork environment, such as regions ranging from untouched Amazonian rainforests to barren deserts to endless arctic sprawl, that aggravate the risks. “You’re outside of the general social context that constrains behavior,” said Sumner. “You’re living with people, we’re often camping out — all the socialization is with the same people you’re working with ... and that often breaks down … some of the behavioral restraints that people who are prone to harassment feel when they’re around more culture, or where there are more people watching.” Carrie Tribble, a doctoral candidate in UC Berkeley’s Integrative Biology department, confirms as much. She cites the “blurred” line between work and free time, lack of privacy, and unclear social boundaries as key factors influencing the prevalence of sexual violence incidents at field sites. As a member of a larger group of graduate students, Tribble is drafting a code of conduct and a series of safety trainings that expedition-bound field scientists can use to inform themselves and prevent sexual violence. “People are often in isolated environments, and that can mean you are away from any type of human population,” said Tribble, elaborating on the risks posed by field sites. “You’re in the middle of a forest — maybe you don’t even have cell coverage — so if something does happen, it is much more difficult to make contact with outside people and to get help.” Often, field scientists have nowhere to turn, especially when the assailant is the one in charge. Many on-site supervisors are unaffiliated with the university or other research organizations and may not be bound by policies. Tribble describes this process as a “jurisdictional nightmare.” “If someone is studying with a faculty

CARRIE TRIBBLE is a doctoral candidate in the Integrative Biology department at UC Berkeley. This photo was taken during a field study. Tribble works with a team of graduate students to develop training designed to prevent sexual violence from occurring on field sites. PHOTO COURTESY OF CARRIE TRIBBLE

member from another university, it’s the other university that has the most influence over that faculty member,” said Joy Evans, the assistant director for survivor support services at the UC Berkeley PATH to Care Center. Evans is well-acquainted with the ways in which sexual harassment manifests itself in academic spaces. She’s worked to combat the issue since she started working at the PATH to Care Center three years ago. When she considers the specific contexts that perpetuate harassment in academia, she emphasizes the role of power dynamics. Oftentimes, professors have complete control over their students’ future career trajectory. “Someone feeling or truly being a gatekeeper for the career trajectory sets up a dynamic where a person has a lot of power and control … it can become challenging really quickly,” said Evans. It’s an issue that Tribble mentions as well, citing an example of a professor who waited until she had achieved the security of tenure before coming forward with allegations of harassment that had taken place during her graduate studies. For the PATH to Care Center, the process of accommodating the needs of the Berkeley community can feel at times like “building a plane while you’re flying it.” The on-campus center employs a small group of advocates who use a holistic approach, providing access to not only legal and medical resources, but also to alternative and equally necessary forms of support. In recognizing that survivors have a right not to report an incident, PATH to Care emphasizes alternative approaches to healing and helps survivors navigate the legal and

support systems at their disposal. Quite commonly, students approach PATH to Care seeking aid in obtaining academic accommodations. “It’s a question of our capacity for being empathetic and being there for something they need,” explained Evans, citing examples of requests for assignment extensions, permission to skip classes, and other accommodations. But in STEM, some of these exceptions or adjustments can be impossible to fulfill. “STEM gets particularly tricky around some of the deadlines and the things that build on each other — if you’re not in the lab, there’s not an alternative.” The challenges survivors face moving forward with scientific pursuits can be an impossible one, forcing many out of the discipline entirely. For those that remain, it can have damaging ramifications for their scientific careers and negatively impact their sense of workplace security and safety. Dr. Janet Stemwedel, a professor of philosophy at San Jose State University, knows this all too well. Nearly 24 years ago, early on in her doctoral program, Stemwedel alleges that she was sexually harassed by a visiting speaker invited to her university’s department colloquium. According to Stemwedel, she had “no reason to believe” that anyone would take her word about the incident over

“OFTENTIMES, PROFESSORS HAVE COMPLETE CONTROL OVER THEIR STUDENTS’ FUTURE CAREER TRAJECTORY.” THE PUBLIC HEALTH ADVOCATE | 23


“‘THEY FACE OTHER CHALLENGES THAT WOMEN ACROSS THE GLOBE FACE — WHICH INCLUDES SEXISM, SEXUAL HARASSMENT, LOWER PAY, OR FEWER OPPORTUNITIES FOR PRESENTATIONS OR RESEARCH PAPERS,’ EXPLAINED RAMIREZ. ‘IT’S DEATH BY A THOUSAND CUTS.’” that of the visiting speaker. The incident went unreported and Stemwedel went through a painful emotional process familiar to many survivors. “We spend a long time coming to grips with it, trying to figure out how to deal with it, because it’s the kind of thing that really narrows our footprint within our discipline,” said Stemwedel. “You spend a lot of time at conferences trying to make sure you don’t accidentally go to a session where your harasser is on the panel. You try to make sure you’re not going to walk into a situation where you’re blindsided, and you spend a lot of time trying to figure out who else in your community of practice you can actually trust.” Since then, Stemwedel has committed herself to advocating for survivors of sexual harassment. As a philosopher, she focuses on ethical behavior in science and emphasizes that sexual harassment can be considered a question of scientific

JANET STEMWEDEL is a professor of philosophy at San Jose State University. Stemwedel works as a philosopher who evaluates the ethics of different behaviors manifested by scientists, including sexual harassment. PHOTO COURTESY OF JANET STEMWEDEL

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integrity, right alongside falsification of data and plagiarism. In her view, sexual harassment is often informed by discriminatory gender practices. Women are faced with overcoming a greater number of obstacles, including sexual harassment, in order to match the achievements of their male counterparts. Their failure to do so is often misinterpreted as the result of a lack of passion or stamina. In practice, it’s the reason so many scientific professions remain maledominated. According to Elsevier’s 2017 report “Gender in the Global Research Landscape,” in a given five-year period, men on average produce and publish more papers than their female counterparts. The report also cites that in 2015, women only made up 28% of all researchers globally. There tends to be a relatively equal number of male and female scientists at the student level, but by the time these scientists have developed more fullyfledged careers, a significant number of these women have exited the research sphere. The phenomenon known as the “leaky pipeline” is perhaps best explained by Dr. Kelly Ramirez, the co-founder of 500WomenScientists. “Once women enter graduate school, a whole new set of challenges emerges …. Not only have women been told that their brains can’t handle science, but they face other challenges that women across the globe face — which includes sexism, sexual harassment, lower pay, or fewer opportunities for presentations or research papers,” explained Ramirez. “It’s death by a thousand cuts.” “Let’s say you make it through — you’re ready to be a faculty position — but you maybe didn’t get the best grant, you didn’t get as many publications … it’s harder for you to get a position, and

if you do get a position, you continue to face those challenges.” 500WomenScientists combats this issue first and foremost by constructing a vast network of women across the globe, building connections between female scientists where none may exist in the immediate vicinity. Women are encouraged to consider how they can come up with solutions specific to gender-related issues within their own communities. For instance, Ramirez believes placing more female scientists in leadership positions is one of the most important solutions that will help mitigate these problems. Ultimately, Ramirez subscribes to the same belief as Sumner: If you want to address sexual harassment in the sciences, you have to start by talking about it. “A lot of the times, if you’re not saying it out loud, people don’t acknowledge there’s a problem,” said Ramirez. “There is a problem with sexual harassers not being punished in any way — if we don’t say that out loud, we are never going to be thinking of solutions to that problem.” 

ABOUT THE AUTHOR

Shannon O’Hara is a junior Molecular Environmental Biology major with a minor in journalism. In addition to writing, Shannon works as a research assistant studying the seasonality of tuberculosis for Professor Justin Remais, as well as studying the impact of sustainable agricultural management on biodiversity for Professor Claire Kremen.


UNDOING ILLNESS WITH DEAN ORNISH, MD

Dr. Dean Ornish is a physician and researcher who has shown that chronic illnesses, such as heart disease, Type 2 diabetes, and early stage prostate cancer, can be reversed through lifestyle changes.

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eart disease is an American crisis. According to the Centers of Disease Control and Prevention, coronary artery disease (CAD) caused a quarter of all deaths in the United States and cost the country upwards of $317 billion in 2016 alone. Despite the various medications and surgeries available to treat heart disease, such as statin drugs, bypass surgery, angioplasty, and stents, CAD remains the United States’ No. 1 killer for both men and women. Many Americans mistakenly believe that heart disease is simply a result of genetics, but at its core, CAD is a lifestyle disease and a consequence of the standard American diet. The U.S. Department of Agriculture (USDA) estimates that 88% of calories from the standard American diet consist of animal foods and highly processed plant foods, such as oils, sugars, and refined grains.

BY NAOMI EPPS Reversing Heart Disease: Changing the Paradigm of Chronic Illness Dr. Dean Ornish is a physician, clinical professor, and researcher at UCSF Medical School. He has published his research in the Journal of the American Medical Association, The Lancet, The American Journal of Cardiology, Health Psychology, and the European Journal of Heart Failure. In the past four decades, he and other researchers have amassed evidence which shows that lifestyle changes may “not only help prevent, but even reverse common chronic diseases at a fraction of the cost.” In some cases, Ornish’s program could even “help people get off of medications that they’d been told they’d have for the rest of their lives.” Ornish came to this conclusion through numerous randomized control

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trials. In one such trial, patients who underwent comprehensive lifestyle changes had a fourfold increase in blood flow to the heart compared to patients in the randomized control group after five years. In 1995, the results of Ornish and his colleagues’ research were published in a paper titled “Changes in myocardial perfusion abnormalities by positron emission tomography after long-term, intense risk factor modification” in the Journal of the American Medical Association. During the following decades, Ornish and his colleagues continued to develop and expand their program for reversing heart disease. The nine-week program consists of two four-hour sessions per week, in which patients work with an exercise physiologist, meditation teacher, and psychologist. They partake in eating healthy meals while listening to lectures on the benefits of lifestyle changes. The lifestyle changes Ornish’s program, which can be viewed on his website, requires of its participants include eating a whole-foods plant based diet, performing regular and moderate exercise, practicing stress reduction, and fostering supportive relationships. A whole-foods plant based diet consists predominantly of fruits, vegetables, legumes, and grains in their whole form. It eliminates meat, poultry, and fish, but the program allows no more than two servings of non-fat dairy food per day and egg whites, as long as dietary cholesterol doesn’t exceed 10 milligrams per day. It also limits dietary fat to 10 percent of daily calories. The program suggests at least 30 minutes of daily

“IN THE ‘90S, ORNISH’S PROGRAM WAS IMPLEMENTED INTO 53 CLINICS AND HOSPITALS AROUND THE COUNTRY AND EXPERIENCED SUCCESS IN REGARDS TO ITS PATIENT OUTCOMES, ADHERENCE RATES, AND COST SAVINGS. ” 26 | FALL 2018

DEAN ORNISH is currently a professor at UCSF Medical School. He has shown, through several studies, that lifestyle changes can help reverse certain chronic diseases. PHOTO BY CHRISTOPHER MICHEL

aerobic exercise or an hour every other day, in addition to strength training two to three times per week. It also implements a daily relaxation practice, such as deep breathing, meditation, or yoga. Lastly, patients participate in two hours of a weekly support group to help foster supportive relationships. In the ‘90s, Ornish’s program was implemented into 53 clinics and hospitals around the country and experienced success in regards to its patient outcomes, adherence rates, and cost savings. However, without reimbursement from insurance companies, many sites closed down. “If it’s not reimbursable, it’s not sustainable,” Ornish sadly realized. This epiphany set Ornish off on a sixteen year journey, working with Medicare to get his program for reversing heart disease covered. Today, Medicare and many private insurance companies cover his program under the new benefit category, intensive cardiac rehabilitation. The change in reimbursement was a momentous turning point in CAD treatment. Now, Ornish claims his program may be able to “cut [national] healthcare costs in half in the first year,” based on financial reports from Blue Shield. After one year, the 78.1% of participants who remained enrolled in the program experienced significant improvements in body mass index, triglyceride levels, low-density lipoprotein cholesterol levels, and blood

pressure, all of which are risk factors for CAD. The results were published in a 2010 paper titled “The Effectiveness and Efficacy of an Intensive Cardiac Rehabilitation Program in 24 Sites” in The American Journal of Health Promotion.

Traditional Treatment Versus Ornish’s Program How is it that CAD is still killing one in four Americans despite the various treatment plans available to patients? Ornish reports it may be because traditional treatments such as medications and surgeries are not as effective as previously thought. He references the research of Dr. Kathleen Stergiopoulos, who conducted a metaanalysis of randomized clinical trials evaluating the efficacy of stent implants for patients with stable CAD. The trials included nearly 80,000 patients who were randomized into experimental groups that underwent a procedure to insert stents and control groups that only received medication. After her analysis, she found that patients with stable CAD who had stents implanted had no significant benefit over patients who were treated with prescription drugs. Her conclusion that stents were ineffective in preventing chest pain, heart attacks, and death were published in The Archives of Internal Medicine in a 2011 paper titled “Initial


THE ORNISH PROGRAM requires participants to follow a plant-based diet, eliminating meat, poultry, and fish. coronary stent implantation with medical therapy vs medical therapy alone for stable coronary artery disease: meta-analysis of randomized controlled trials.” Different forms of traditional treatment for chronic illnesses have undoubtedly prolonged millions of lives and continue to be vital for acute care. However, Ornish believes the reason behind his program’s success in comparison to other traditional treatments for CAD lies within the nature of chronic diseases. While it is commonly understood that chronic illnesses stem from a variety of different causes that can be specifically targeted by drugs or procedures, Ornish asserts that these non-communicable diseases “are different manifestations of disorders of the same [underlying] biological mechanisms.” In other words, physicians and patients must address the causes of these illnesses, rather than just the symptoms such high cholesterol or blood pressure. There remains some skepticism in regards to the practicality of the Ornish program’s strict lifestyle changes. Experts often acknowledge the validity of Ornish’s research, while

also suggesting his recommendations may be too difficult for some to follow through with. For example, U.S. News Health experts ranked Ornish’s diet No. 2 under their heart health category, due to the supporting scientific literature, but ranked it No. 9 overall because they believed the strict guidelines may be a challenge for some people. Similarly, experts at The American Council on Science and Health assert that they “can’t wholeheartedly agree that diets beneficial for people with heart problems are necessarily the best for everyone.” Instead, they prefer to promote the motto “everything in moderation.” When asked about his views on moderation, Ornish asserted that an ounce of prevention is worth a pound of cure. He’d like to assure readers that if you don’t have a life threatening disease, and your goal is to simply lose weight or lower your blood pressure or cholesterol, it is not necessary to follow the program’s guidelines perfectly. Instead, he suggests creating attainable goals to progressively improve lifestyle habits over time. While “everything in moderation” may be sufficient for preventing diseases, Ornish asserts the same is not

“AN OUNCE OF PREVENTION IS WORTH A POUND OF CURE.” true for reversing them. “I’d love to tell people that eating the [USDA] Dietary Guidelines — meat, and saturated fat, and sugar is going to reverse your disease, but it won’t. Whether or not you want to [change your lifestyle] is a personal choice, but I think people need to know what the facts are, and then they can decide.” 

ABOUT THE AUTHOR

Naomi Archer Epps is a junior studying public health and statistics. She is a Certified Domestic Violence Advocate and is a vocal proponent for community health initiatives in her hometown of Santa Cruz, CA. In her free time, Naomi likes to horseback ride, dance with friends, and read.

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THE UGLY SIDE OF BEAUTY PRODUCTS The beauty industry has grown into a multibillion-dollar industry. Do the millions of global consumers know what their beauty products are comprised of? BY AMY ZHANG

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n light of the millennial obsession with beauty products and Instagramready looks, the beauty industry has grown to an outstanding $445 billion. However, while consumers flood the market with high demand for cheap eyeliner, mascara or eyeshadow, most often fail to consider the harmful effects of chemicals such as parabens and phthalates listed on the labels of lubricant products such as lotion and eye makeup. Many times manufacturing companies disguise these ingredients with vague and ambiguous terms such as “fragrances”. With the help of more investigation into the effects of preservative compounds on biological systems by public health researchers, as well as more informational databases, propagation of knowledge would help consumers make the right decisions for their health.

Chemical Pseudonyms Unmasked Several cosmetic products contain potentially endocrine-disrupting compounds such as phthalates (used in fragrance), parabens (used as preservatives in makeup), and triclosan (found in antibacterial soap and toothpaste). However, often times even informed consumers on the effects of parabens and phthalates are unaware that their lotion products contain these harmful chemicals, as they are usually disguised under the overarching term of “fragrances” or “parfum.” As stated by the organization Environmental Working Group (EWG) on their Skin Deep website, “The word ‘fragrance’ or ‘parfum’ on the product label represents an undisclosed mixture of various scent chemicals and ingredients used as fragrance dispersants.”

Exposure Pathway and Assessment The myth that 60% of what we put on our skin is absorbed by our bodies has been debated for years. In reality, the truth of this statement depends drastically on the nature and molecular components of the specific compound. In a document published by the Food and Drug Administration (FDA), they specify that “the passive

transport of many nanomaterials may not occur through intact skin, but there is an increased probability for entry of nanomaterials through skin with an impaired barrier layer.” This suggests that makeup products in the form of powder can be transferred through ruptured skin areas, such as places where one might have acne. Additionally, the FDA states that special consideration needs to be taken when looking at skin with an “impaired barrier,” such as from sunburn or dermatitis, as these conditions could allow for easier transmittance of chemicals pass the skin and into the bloodstream. This can be seen when silicone additives like dimethicone sit on top of the skin and don’t allow anything to absorb. However, in the case of phthalates and parabens, smaller ester compounds are easily absorbed by the skin. Because of their volatility, DEP (diethyl phthalate) and DMP (dimethyl phthalate) are present in higher concentrations in the air in comparison to the heavier and less volatile DEHP (Bis(2-ethylhexyl) phthalate), contributing to the toxicity of the airborne transmittance to the surrounding environment as well. As a result, consumers need to be aware of not just one, but multiple pathways of exposure that open up more avenues of health risks.

Educating the Future Generation The HERMOSA projected conducted by the UC Berkeley Center for Environmental Research and Children’s Health (CERCH) reached out to 100 teenage girls in Salinas Valley and gave them alternative cosmetic products that were phthalate-, paraben-, and triclosanfree. They later tested the subjects using urine analysis and detected significantly decreased levels of phthalates and parabens after only about three days of testing. These products contained several replacements such as alcohol-based sanitizers as effective antibacterials as well as zinc oxide as an antimicrobial preservative for topical products. Through an interview with one of the

“OFTEN TIMES EVEN INFORMED CONSUMERS ON THE EFFECTS OF PARABENS AND PHTHALATES ARE UNAWARE THAT THEIR LOTION PRODUCTS CONTAIN THESE HARMFUL CHEMICALS...” research scientists on the project, Dr. Kimberly Berger stated that “this study showed that using alternative products were pretty easily integrated into the teenagers’ everyday routine, which might make it easier to implement on a community scale.” The project empowered local youth in Salinas by engaging them in this research through data analysis and research design. Community outreach education was implemented by disseminating info sheets in English and in Spanish titled “Are your cosmetic products safe?” Additionally, Berger recommended that all product consumers conduct proper research about the different chemicals and the health outcomes and effects associated with their beauty products. The largest databases include EWG’s Skin Deep Cosmetic database and the California Safe Cosmetics Program chemical list. By keeping the community well informed about the behind-thescenes production of consumer goods, public health educators are able to help consumers make the right choices to protect their health. 

ABOUT THE AUTHOR

Amy Zhang is a junior majoring in Environmental Sciences. She plans on pursuing a career in environmental medicine and occupational health. In her free time, she enjoys hand lettering quotes and playing guitar.

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THE SUPERHUMANS BEHIND THE GARBAGE TRUCKS Sanitation work is considered the fifth most dangerous job in the United States. How often do we acknowledge the danger of this industry? BY ELISE RIO

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hen we think of dangerous jobs, we often think of the police officer on the streets fighting crimes or the firefighters rushing into a burning house to rescue families. Many of us do not think about our garbage man. Similarly, when we think of people on the front lines of protecting the health of our cities, on the front lines of public health, we may think of researchers, doctors, public health officials, and maybe even politicians. We do not often think of the 5 a.m. trash collector. Sanitation work is one of the most overlooked, yet important, jobs in America, but many don’t expect it to

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be one of the most dangerous. But dangerous it is. According to TIME Magazine, sanitation work is the fifth most dangerous job in the United States, with 34.1 fatal injuries per 100,000 workers, only behind logging workers, fishermen, roofers, and aircraft pilots. However, sanitation workers are critical to the health of our population. Many of us cannot imagine what our lives would be like if nobody took away the approximate 250 million tons of trash we produce every year. Without sanitation workers, trash would accumulate in our streets, leak into our water supply, and spread devastating diseases, such as yellow fever and cholera, across our

overcrowded cities. If sanitation workers are such a critical part of our daily lives, why are they so underappreciated and why is their job so incredibly dangerous? Dr. Robin Nagle, an anthropologist from New York City who joined The City of New York Department of

“ACCORDING TO TIME MAGAZINE, SANITATION WORK IS THE FIFTH MOST DANGEROUS JOB IN THE UNITED STATES.”


Sanitation (DSNY) for several years, reports about her experience on the job in her book, Picking Up: On the Streets and Behind the Trucks with the Sanitation Workers of New York City. She explains that there is no such thing as putting our trash in a place. We throw trash away. Just this construction of the phrase represents our relationship with the trash we produce. “Throwing” implies that we want it as far from us as possible, and “away” signifies a place we cannot see. As soon as an object becomes trash, we no longer want to be even remotely associated with it. Society does not pay much heed to workers in the trash industry. Trash is dirty and ugly and it reminds us of our never-ending waste. It makes us feel guilty, so we turn a blind eye to anything related to trash, including the people who work among the trash. According to Nagle, garbage workers are often stigmatized and discerned to be at the lowest level in society; teachers warn students to work harder in class to avoid becoming garbage men, and dating websites even use quotes such as “Why settle for a garbage man when you can have a stockbroker?” Because we are so reluctant to hear about trash, we are also reluctant to hear about the people who work in the trash, and we often dehumanize them. Nagle explains that when sanitation workers put on their uniforms, they become invisible to the world. The general public does not perceive sanitation workers the same way as others around them. People rarely acknowledge their presence, insult them, and tragically, sanitation workers can even end up under the wheels of our cars, contributing to the extremely high mortality rate of 34.1 fatal injuries per 100,000. Not only do sanitation workers suffer automobile injuries, but they are also often injured on the job as well when people are reckless with their garbage. Nagle describes the injuries sustained by sanitation workers as being poked by strange needles, cut by broken glass, and killed by improperly disposed of chemicals. In New York, in 1996, a

sanitation worker was killed when a bag of trash filled with hydrochloric acid exploded and drenched the man picking it up. Nobody was ever held responsible. While other public servants of New York receive benefits for the dangerous and essential services that they provide for the city, sanitation workers rarely receive any compensation. They do not receive discounts at restaurants or stores similar to firefighters and police officers, and unlike other public servants, they are not protected by policies passed by the government, such as health care coverage and paid leave. Sanitation workers are almost never thanked while on the job, and, if anything, are often met with insults due to noises from their equipment in the mornings. In her book, however, Nagle describes that many sanitation workers take pride in their work. When two sanitation workers from UC Berkeley discussed their work at the University, they explained that they were proud to make Berkeley a campus conducive to learning. The Berkeley sanitation workers are proud to be cleaning up the classrooms, hallways, and bathrooms in the morning before the students wake up and come to class. Sanitation workers are essential to public health and to our daily lives and they deserve more respect from all of us. Not only should we be mindful of our trash for environmental reasons but we should also be mindful that when we throw trash away it becomes someone else’s responsibility. We should all take an extra second every day to consider the extremely hardworking people who continually risk their lives to keep our cities clean. We can also consider offering up a bit of ourselves — a smile, a thank you, or a lending hand — when we run into one of these superhumans who work behind the wheels of the garbage trucks and on the streets of our cities. 

“WHEN TWO SANITATION WORKERS FROM UC BERKELEY DISCUSSED THEIR WORK AT THE UNIVERSITY, THEY EXPLAINED THAT THEY WERE PROUD TO MAKE BERKELEY A CAMPUS CONDUCIVE TO LEARNING.”

ABOUT THE AUTHOR

Elise Rio is a junior majoring in Molecular Environmental Biology, Global Studies, and Anthropology with a minor in Global Public Health. Elise is very interested in studying global health as well as the social structures in place that affect health and healthcare in the community and hopes to earn an MD/ PhD after she graduates from Berkeley. In her free time she loves to sail, travel, scuba dive, explore fun places, and drink white mochas at Strada.

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