The Public Health Advocate: Uncharted Waters (Fall 2019)

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PUBLIC HEALTH ADVOCATE FALL 2019

UNCHARTED WATERS 4 THE METHAMPHETAMINE EPIDEMIC, LOCALLY AND NATIONALLY 13 WHAT’S WRONG WITH PHYSICAL EDUCATION? 19 THE NEEDLE EXCHANGE PROGRAM CRISIS

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PUBLIC HEALTH ADVOCATE

TABLE OF CONTENTS

A UC BERKELEY UNDERGRADUATE PUBLIC HEALTH JOURNAL

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FALL 2019 ISSUE

EDITORIAL BOARD EDITORS-IN-CHIEF Brandon Chu Ilhaam Burny

The Methamphetamine Epidemic, Locally and Nationally

PRINT MANAGING EDITOR Subeksha Sharma

Driving Towards a Healthier Future

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ONLINE MANAGING EDITOR Jennifer Kwon DECAL MANAGERS Haley Chen Manisha Sahoo

Out for Blood

STAFF

COPY EDITORS Claire Maher Kahyun Koh Nhat Nguyen Ronit Gupta Saher Daredia

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CONTRIBUTING WRITERS Ammar Bhaiji Amy Rich Felicia Zhornitsky Navya Pothamsetty Raneem Rayes

Ensuring Reproductive Justice for All 22

WITH SPECIAL THANKS TO Public Health Alumni Association SCHOOL OF PUBLIC HEALTH

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What’s Wrong With Physical Education?

America’s Measles Crisis and the AntiVaccine Movement

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The Needle Exchange Program Crisis

LETTER FROM THE EDITORS

Dear readers, For this issue, our editorial board chose the theme “Uncharted Waters,” a decision that was driven by the unexpected political and climatic events on our local and global stage. In our home state, residents are adjusting to the new normal of severe wildfires and sudden power shutoffs. Those who rely on electricity for their safety, particularly the most vulnerable among our society, now face an unpredictable reality during wildfire seasons. On the international stage, we have witnessed devastating fires in the Amazon, the repeated extension of Brexit in the United Kingdom, and long-standing protests in Hong Kong.

Through this haze of uncertainty, we are also adapting. In light of this semester’s canceled classes, UC Berkeley adopted a resilience strategy that will allow instructors to continue its educational mission despite external events. Internationally, a young Swedish activist named Greta Thunberg captured widespread attention in her efforts to open the world’s eyes to the effects of climate change. And in October, Russia formally accepted the Paris Climate Agreement.

“Uncharted Waters” reflects the work our writers have done this past semester in navigating the uncertain world in which we now live. In “Out for Blood,” Nhat Nguyen explores how changing demographics of blood donors presents an urgent problem in maintaining our healthcare system. “Ensuring Reproductive Justice for All” by Amy Rich recounts how the efforts of our fellow peers helped make medication abortion accessible to thousands of college students across California.

As your peruse the articles in this issue, we encourage you to consider how uncertainties in your life affect your health and how you and your community can adapt and overcome these challenges. Even though these waters may be uncharted, they might be navigable for us all.

Your advocates,

Brandon Chu and Ilhaam Burny

THE PUBLIC HEALTH ADVOCATE | 3

THE METHAMPHETAMINE EPIDEMIC, LOCALLY AND NATIONALLY As the production of methamphetamine increases exponentially, San Francisco struggles to look for solutions.

BY FELICIA ZHORNITSKY

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here has been a dramatic increase in methamphetamine abuse in recent years in the United States of America. While the opioid crisis has received mass media attention, the mainstream news and Americans as a whole are unaware of the rising threat of meth on the horizon. Meth is back on the streets in purer forms and is more accessible than ever before, and its effects can be seen in San Francisco.

Methamphetamine is not a new issue in the United States. The grapple with methamphetamine abuse reached a peak in the mid-2000s, when domestic labs in Western, Midwestern, and Southern states were the main suppliers.

The national ban of over-the-counter sales of cold and allergy medicines that contain ingredients used to synthesize methamphetamine as well as additional state measures made it difficult for these domestic labs to function, and the use of methamphetamine dropped for a period.

In recent years, however, the task of making meth has been picked up by socalled “super-labs” run by drug cartels based in Mexico. While the domestic labs of the 2000s could produce many small batches, “super-labs” release hundreds of pounds of 90 to 95 percent pure meth a day. According to the United States Customs and Border Protection, there were 56,362 pounds of meth seized at the border in 2018, which is about a 285 percent increase since 2014. In contrast, the amount of

“IN RECENT YEARS, THE TASK OF MAKING METH HAS BEEN PICKED UP BY SO-CALLED ‘SUPER-LABS’ RUN BY DRUG CARTELS BASED IN MEXICO.” drugs such as heroin and cocaine seized at the border has dropped. Once the methamphetamine floods into the U.S., its abundance and cheap price make it a tempting offer for underprivileged marginalized groups and struggling addicts. The rising epidemic is having a big impact on states in the Midwest and

Pacific Northwest, and it is especially evident in San Francisco.

Methamphetamine addiction has led to grave consequences in San Francisco.

According to Erin Allday, a reporter for the San Francisco Chronicle, “Methamphetamine overdose deaths doubled over the past decade, even as opioid fatalities stabilized. ...

Meth-related emergency room visits skyrocketed more than 1,200 percent from about 150 in 2008 to nearly 2,000 in 2016.” In addition, the San Francisco Department of Public Health reports that about 50 percent of the 7,000 annual psychiatric emergency visits at Zuckerberg San Francisco General Hospital are patients that are high on meth.

How does methamphetamine affect users and why is it dangerous? In the short term, meth increases wakefulness and physical activity; brings a euphoric rush; and leads to an irregular heartbeat, increased respiration, and higher blood pressure. In cases of overdose, it can lead to hyperthermia and convulsions, which will lead to death if untreated. As methamphetamine is a highly addictive stimulant, constant users will develop tolerance to its euphoric effects and will take more and more to produce the same feeling. In addition, constant meth users can experience severe anxiety, confusion, violent episodes, and psychotic behavior such as paranoia, hallucinations, and delusions. These psychotic symptoms can persist even long after someone has stopped using meth.

Neuroimaging studies of the brains of meth abusers have shown that meth changes the structure and function of the parts of the brain associated with emotion, memory, verbal learning, and the removal of damaged neurons.

Although the studies revealed that some parts of the brain will go back to normal after prolonged abstinence from the drug, much of the damage is irreversible. In addition, the use of methamphetamine has been correlated to an increased risk for stroke and Parkinson’s disease. Constant meth users also experience tooth decay and skin sores.

“THE SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH REPORTS THAT ABOUT 50 PERCENT OF THE 7,000 ANNUAL PSYCHIATRIC EMERGENCY VISITS AT ZUCKERBERG SAN FRANCISCO GENERAL HOSPITAL ARE PATIENTS THAT ARE HIGH ON METH.” Methamphetamine addiction has a particularly devastating effect on the most vulnerable parts of the population.

Many people who struggle with meth use are facing housing instability and financial issues. People who do not have a home to go to at night often report using methamphetamine to stay awake and protect themselves from the dangers that come with sleeping on the streets.

Low-income individuals and recent immigrants are at risk to start using methamphetamine to alleviate the stress from socioeconomic instability. Barriers such as a lack of transportation and fear of authority prevent these folks from being able to access treatment.

To address this issue, the City and County of San Francisco has put together a methamphetamine task force, co-chaired by Mayor London Breed and Supervisor Rafael Mandelman.

Other members of the task force include specialists in addiction research, public health representatives, and methamphetamine users. The goal of the task force is to come up with policy solutions that would increase aid to users and guide them into recovery instead of pressing criminal charges.

“METHAMPHETAMINE ADDICTION HAS A PARTICULARLY DEVASTATING EFFECT ON THE MOST VULNERABLE PARTS OF THE POPULATION.” THE PUBLIC HEALTH ADVOCATE | 5

SIDE-BY-SIDE COMPARISONS of two brain scans measuring dopamine transporter activity are shown above. On the left, the scan of a normal control shows increased dopamine transporter activity. On the right, the scan of a methamphetamine abuser shows decreased dopamine transporter activity and compromised mental function.

PHOTO BY THE NIH/NATIONAL INSTITUTE ON DRUG ABUSE

According to Erin Mundy, Mandelman’s legislative aide who focuses on homelessness and substance abuse, “The meth task force is an opportunity for everyone to get into one room and share ideas. There’s a lot of amazing work going on, but people aren’t always communicating with each other. The meth task force is the exact way to do so.” Other than increasing access to treatment, the task force aims to improve street response to 911 calls for people exhibiting signs of methinduced psychosis. Often, these people are not in need of the police but rather a well-trained professional to de-escalate

“OTHER THAN INCREASING ACCESS TO TREATMENT, THE TASK FORCE AIMS TO IMPROVE STREET RESPONSE TO 911 CALLS FOR PEOPLE EXHIBITING SIGNS OF METHINDUCED PSYCHOSIS.” 6 | FALL 2019

the situation.

The task force is also working on public education campaigns and creating focus groups for users and people close to them. “We need to have an appropriate response so that the community feels safe and people in crisis have the resources they need,” Mundy states. “We are hoping to be a model for other cities so that if the [methamphetamine] crisis spreads to other cities, they can look to San Francisco and the meth task force.”

In the meantime, various organizations and treatment programs in the Bay Area are doing their best to provide for the struggling community. These include the Positive Reinforcement Opportunity Project run by the San Francisco AIDS Foundation, which promotes incentive-based abstinence from methamphetamine use, and respite centers that provide counseling and guidance services.

Methamphetamine use has had a dramatic resurgence in the United States and has a particular impact on marginalized groups in San Francisco.

Without the support of the community, these individuals will fall through the cracks and not get the support that they need. With increased education and the advocacy of the general public, methamphetamine users will be able to start on the path to recovery. 

ABOUT THE AUTHOR

Felicia Zhornitsky is a second-year intended Public Health major who is interested in infectious diseases and international health.

In addition to writing for PHA, she mentors children at a local elementary school and competes with the Cal Ballroom team. She enjoys poetry, performances, and exploring new places.

DRIVING TOWARDS A HEALTHIER FUTURE Traffic congestion is more than just a daily annoyance.

It can negatively impact your health.

BY AMMAR BHAIJI

THE PUBLIC HEALTH ADVOCATE | 7

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hen the average person is stuck in traffic because of rush hour, a mixture of emotions often result. They feel anger about wasting precious time waiting around for cars to merge onto the freeway. They are frustrated with the monotony of sitting around in their car.

More importantly, they feel that those minutes or hours are spent stuck behind the wheel rather than with their best friends or family.

Traffic congestion is a major problem around the world. With a growing middle class, more cars are on the road than ever before. This means our antiquated infrastructure systems are used beyond their limits, resulting in traffic congestion. People have known for years that traffic congestion is economically detrimental, but only recently are they becoming aware of the health implications associated with traffic congestion.

“AMERICANS LOSE AN AVERAGE OF 97 HOURS OR 4.04 DAYS IN TRAFFIC CONGESTION PER YEAR — A STATISTIC THAT IS PREDICTED TO INCREASE EVEN MORE IN THE FUTURE.” Traffic congestion wastes time and money. A 2018 study by the global transportation consulting firm INRIX that gathered data from more than 200 cities in 38 countries found that Americans lose an average of 97 hours or 4.04 days in traffic congestion per year — a statistic that is predicted to increase even more in the future. Think about it: More time stuck in traffic leads to longer delivery times for products, missed meetings, and wasted employee working hours. All of this translates to lost revenue for companies that rely on employees to come into work or that need products shipped by land.

Congestion is a multifaceted issue.

For example, highway and roadway infrastructure is outdated and cannot

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handle current traffic demands.

However, attempts at fixing existing roads or creating alternative ways to travel are often unappealing. Infrastructure repairs are time-consuming and can inconvenience commuters. Public transportation systems are designed inefficiently and stigmatized negatively.

We are convinced that cars save time, afford independence and privacy, and symbolize wealth. Analyzing the root causes of traffic congestion is the first step towards creating effective solutions.

According to the U.S. Department of Transportation, there are two main types of traffic congestion: recurring and non-recurring. Recurring traffic congestion is due to chronic issues such as physical capacity restraints on highways, while non-recurring traffic congestion is a temporary or acute buildup of traffic due to unique events.

Both recurring and non-recurring traffic congestion events exacerbate existing respiratory tract issues and lead to new cases of asthma and other respiratory illnesses, but research has also shed light on the less obvious physical side effects of particulate matter ingestion. Internal combustion engines, and any mechanism involving combustion, will release minute particles of matter, known as particulate matter.

Particulate matter, or PM, is a general term used to describe a collection of substances that are suspended in the air.

They can include familiar pollutants, such as dust and pollen, and unfamiliar ones, such as polycyclic aromatic hydrocarbons (PAHs). PAHs are found in higher concentrations when diesel is combusted than when normal gasoline fuel is combusted.

Dr. Katharine Hammond, a professor of environmental health sciences at the UC Berkeley School of Public Health, conducted a study that demonstrated for the first time that diesel exhaust from trains was linked to increased instances of cancer. During the 1970s energy crisis, Hammond described the urgent need for research on the effects of diesel exhaust on human health.

At the time, the market was moving towards diesel engines because they

had better fuel efficiency. However, the U.S. Environmental Protection Agency (EPA) was concerned that diesel engines, which were quantitatively known to release more particulate matter, would become common and pollute the air. As a result, the EPA sponsored Hammond’s study, which found that diesel exhaust, which is chiefly made of particulate matter, caused high incidences of cancer in railroad workers who interacted with particulate matter through their work.

In response, California classified diesel exhaust as a toxic contaminant and implemented programs to reduce its presence.

Hammond also spoke about one indirect effect of particulate matter ingestion, specifically through the immune system. She noted that PAHs add methyl groups to DNA strands in a process known as methylation.

Methylation is a natural process, but excessive methylation will negatively affect DNA. One of the areas in which methylation has been found to affect DNA is in the production of T-regulatory cells (Tregs), a central part of the immune system. Increased methylation will decrease the function of these Tregs, thereby inhibiting nonspecific and specific immune responses.

Additionally, research has suggested that if ingested, particulate matter may actually be a contributing factor towards obesity and diabetes. Hammond’s team hypothesized that particulate matter can cause oxidative stress, which leads to systemic inflammation.

This inflammation can lead to the

“RESEARCH HAS SUGGESTED THAT IF INGESTED, PARTICULATE MATTER MAY ACTUALLY BE A CONTRIBUTING FACTOR TOWARDS OBESITY AND DIABETES. PARTICULATE MATTER CAN CAUSE OXIDATIVE STRESS, WHICH LEADS TO SYSTEMIC INFLAMMATION.”

formation of fat and the destabilization of glucose levels. Additionally, systemic inflammation is a contributing factor towards cancer, heart attacks, and heart disease.

When posed with the question of how to best reduce pollutants as a result of traffic congestion, Hammond noted that it will require coordinated and interdisciplinary solutions. For example, it will require innovation and

“REDUCING POLLUTANTS AS A RESULT OF TRAFFIC CONGESTION WILL REQUIRE COORDINATED AND INTERDISCIPLINARY SOLUTIONS.”

technological advancements in particle traps on trucks that reduce the amount of particulate matter released. It will also require the large-scale adoption and further innovation of vehicles that use alternative fuels, such as electric vehicles and hydrogen fuel cell vehicles. Hammond also talked about the important role that policymakers will play in creating strict fuel standards at both the state and national levels.

Finally, it requires an effort to reduce our dependence on cars by exploring other transportation options, such as public transit, biking, and walking.

Traffic congestion should be treated as a public health issue and accordingly needs more resources from public health practitioners and the scientific community as a whole. Given the serious health effects of vehicle emissions, public

health experts must merge into the conversation about traffic congestion. 

ABOUT THE AUTHOR

Ammar Bhaiji is a first-year at UC Berkeley intending to major in Public Health, with an emphasis on health policy. In his free time, Ammar enjoys surfing and mountain biking in Northern California.

EXHAUST FROM DIESEL ENGINES contains a high level of particulate matter, or PM. Continued exposure to this exhaust can result in a higher incidence of cancer, as seen in railroad workers.

THE PUBLIC HEALTH ADVOCATE | 9

OUT FOR BLOOD As modern treatment methods are developed, blood shortages are an increasingly bigger barrier in healthcare. Where are the donors?

BY NHAT NGUYEN

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SURGICAL PROCEDURES often require large amounts of blood for blood transfusions. Low supplies of donated blood can force hospitals to triage more urgent medical procedures.

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or both the layperson and the student aspiring to join the healthcare field, the notion of saving lives often invokes images of dramatic surgeries or cutting-edge cancer therapies. However, unseen to the public are the larger health burdens caused not by technological or scientific inadequacies but by a simple lack of resources. The current blood shortage has resulted in severe obstacles to immediate, effective medical care, making those dramatic surgeries and cutting-edge cancer therapies ever more difficult to perform.

In January of this year, a polar vortex unleashed Arctic winds into the Midwest and Northeast, breaking several all-time records. Schools were forced to close, and communities rushed to take care of the homeless on the streets. Due to the extreme cold, snow, and coincidental overlap with an influenza outbreak, approximately 450 blood drives were canceled in 30 states, resulting in a loss of over 14,000 donations.

“A LIVER TRANSPLANT CAN REQUIRE UP TO 120 UNITS OF DONATED BLOOD. THE RED CROSS TYPICALLY NEEDS ABOUT 80,000 UNITS OF BLOOD PER DAY, BUT RECENTLY, IT HAS ONLY ABOUT 36,000 UNITS ON HAND.” Transplants, chemotherapy, and heart surgeries all require enormous amounts of blood products. A liver transplant, for example, can require up to 120 units of donated blood. The Red Cross typically needs about 80,000 units of blood per day, but recently, it has only had about

36,000 units on hand. As a result, various hospitals in Los Angeles, Philadelphia, and Atlanta have been forced to cancel such elective surgeries in favor of more emergent cases such as trauma injuries or difficult child deliveries.

Less than 38 percent of the population is eligible to donate blood, and of the 38 percent who are eligible, less than 10 percent actually donate blood. Over 60 percent of blood that is donated comes from adults over 40 years old. For baby boomers and their children who lived during World War II, blood donation was a cultural norm and civic duty; a needle puncture and an hour or two out of their day was well worth the cost to support troops abroad. Corinne Standefer, for example, has been a loyal donor for 37 years and has donated over 19 gallons of blood. Every 8 weeks, she rolls up her sleeves and joins the group of seniors that comprise the majority of the nation’s blood supply.

“I was born very prematurely,” recalls Michelle Schanible, the team supervisor for the Red Cross blood drive at Berkeley. “I needed lots of blood products to survive. Later, my grandfather got cancer and needed blood products for his chemotherapy. Now, my entire family makes an effort to donate blood more frequently. Working here is me going full circle and paying it back.”

But as this population ages, the current blood shortage is exacerbated by an increased demand for surgical procedures associated with heart disease.

More importantly, however, more and more loyal donors are being phased out and too few young donors are replacing them. Recently, blood services have seen fewer people in their 20s and 30s. Young people may simply lack the same sense of civic duty held by the older generation, but they are also likely more involved in their careers, more mobile, or simply unaware of the need for blood donations to actually contribute.

“I think the problem is partly generational,” said Schaible. “Children usually only donate blood when they’ve seen their parents donate blood because then they’re more comfortable with the concept. My parents, for instance,

“LESS THAN 38 PERCENT OF THE POPULATION IS ELIGIBLE TO DONATE BLOOD, AND OF THE 38 PERCENT WHO ARE ELIGIBLE, LESS THAN 10 PERCENT ACTUALLY DONATE BLOOD. OVER 60 PERCENT OF BLOOD THAT IS DONATED COMES FROM ADULTS OVER 40 YEARS OLD.” donated blood during World War II, so blood donation isn’t anything new to me. But I think we’re constantly losing donors because not all children donate blood like their parents do, and the rate of new donors isn’t enough to make up for it. And something weird I’ve noticed consistently is that more women donate than men. I think their maternal instinct makes them caring and natural providers. I’ve also noticed that they tend to be comfortable with the medical procedures.”

Research throughout the past decade continues to show that an overwhelming number of college students have positive views when asked about blood donation, but only half actually donate. Young healthy college students — particularly male college students — represent an untapped source of willing blood donations and could significantly reduce the blood shortage burden. While it may be disconcerting to think of students as a physical, medical resource, they are perhaps the most accessible group who could feasibly donate blood and replace

“I THINK THE PROBLEM IS PARTLY GENERATIONAL. CHILDREN USUALLY ONLY DONATE BLOOD WHEN THEY’VE SEEN THEIR PARENTS DONATE BLOOD BECAUSE THEN THEY’RE MORE COMFORTABLE WITH THE CONCEPT.” THE PUBLIC HEALTH ADVOCATE | 11

the older generation.

Whether or not there is a world war being waged beyond our borders, blood donation to support our fellow citizens remains our civic responsibility. Be it the volunteer crossing guard next to the neighborhood elementary school or the neurosurgeon that saves the lives of car crash victims, each citizen plays a productive role in the functioning of our society. If we are ever ill or injured, we expect without question that the necessary blood products will be provided. However, blood donation is inherently communal. We take it for granted that we can all rely on blood donations, but this reliance is only possible if everyone gives back. 

“WHETHER OR NOT THERE IS A WORLD WAR BEING WAGED BEYOND OUR BORDERS, BLOOD DONATION TO SUPPORT OUR FELLOW CITIZENS REMAINS OUR CIVIC RESPONSIBILITY.”

ABOUT THE AUTHOR

IN ORDER TO DONATE BLOOD, an individual must weigh least 110 pounds, be of 16 years of age or have parental consent, and generally be in good health. Although many college students are eligible and have positive views about blood donation, less than 50 percent of them actually donate.

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Nhat Nguyen is a second-year intended Molecular and Cell Biology major. In addition to writing for The Public Health Advocate, he also writes for the Berkeley Political Review and works in the Diep Lab at UCSF studying antibiotic resistance. In his free time, he enjoys hiking, playing the piano, and exploring San Francisco.

WHAT’S WRONG WITH PHYSICAL EDUCATION? Physical education has a bad reputation and is often underfunded in schools.

Maybe it’s time for that to change.

BY NAVYA POTHAMSETTY

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etween uncomfortable locker room experiences, endless laps around the track, and gym teachers’ historically unpleasant media representation, most Americans have

“IN RECENT YEARS, THERE’S BEEN A DECREASE IN FUNDS ALLOCATED TO PE WHILE OBESITY RATES IN THE UNITED STATES SKYROCKET.”

negative experiences and attitudes towards physical education, commonly referred to as PE. However, PE doesn’t inherently have to be boring or humiliating. It can be a fun, educational way for students to get recommended levels of exercise and become empowered to lead an active lifestyle. And it’s not that PE teachers are slacking when it comes to curriculum development; most educators and school boards recognize the benefits of a robust physical education program. Rather, PE has historically been de-prioritized

in the public education system, which has lead to a devaluation of programs nationwide.

This trend leads back to President Bush’s No Child Left Behind Act of 2001, which funneled tax dollars into “core academic subjects” to raise national average test scores. To make up for this, programs involving physical education and the arts were cut. Although the bipartisan Every Student Succeeds Act increased PE’s federal funding during the Obama administration, the subject is still not a priority in public education.

THE PUBLIC HEALTH ADVOCATE | 13

This means in recent years, there’s been a decrease in funds allocated to PE while obesity rates in the United States skyrocket. Currently, budget cuts have forced many educators to moonlight as gym teachers while also teaching “core” math or science classes. While PE doesn’t seem like something that should be in core curriculum, normalizing physical activity is incredibly important because we’re stuck with the consequences of our health-related choices for the rest of our lives.

Physical Education and Public Health While there are many ways to exercise, schools are the ideal place to implement physical education programs,

explains Dr. Hannah Thompson, because we have the greatest ability to reach the most children. Thompson, a community health research scientist at UC Berkeley, has worked extensively in physical education and school health.

From a public health perspective, the education system seems like the best way to implement PE on a large scale. Much like school-based interventions are used to roll out vaccinations and antibiotics, compulsory education gives us a valuable framework for currculum structure and standardization, with the same basic physical education foundation for every student.

Another public health concern is the lack of a consistent, equitable opportunity for kids to get physical

activity. PE through the public education system can mitigate health disparities. While children in wealthier neighborhoods benefit from sports leagues and dance studios, PE classes are the only organized way for many

“WHILE CHILDREN IN WEALTHIER NEIGHBORHOODS BENEFIT FROM SPORTS LEAGUES AND DANCE STUDIOS, PE CLASSES ARE THE ONLY ORGANIZED WAY FOR MANY LOWER-INCOME KIDS TO GET MUCH NEEDED EXERCISE.”

PRESIDENT BARACK OBAMA, above, signs the Every Student Succeeds Act of 2016. The Every Student Succeeds Act followed the No Child Left Behind Act and increased federal funding for physical education, but PE continues to be neglected.

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lower-income kids to get much-needed exercise. However, the National Physical Activity Plan (NPAP) found that budget cuts had differential impacts on physical education, resulting in racial disparities.

Thompson maintains that Black and Latinx students are less likely to be physically active and have PE teachers.

These factors lead to lower fitness, which is correlated with poor academic performance, among other adverse outcomes.

Lack of physical activity, especially in young people, has the potential to exacerbate existing health disparities affecting socially vulnerable populations.

Physical education “level[s] the playing field from the beginning,” Thompson concludes, “and evidence shows that it has the potential to have a positive impact.”

Although all physical education programs should follow the same standards, research suggests there are access gaps from school to school.

Students are entitled to a comprehensive physical education, so it’s important to measure whether each program’s implementation is effective. Although PE isn’t as well-researched as other fields in public health, more school-specific data is needed to account for the differential access gap. Schools benefit from specific feedback regarding their performance relative to national standards and realistic solutions. “Schools are not Petri dishes,” Thompson explains, maintaining that the greatest challenge lies in testing program effectiveness in the real world rather than their efficacy in a controlled setting. Although schools would like to have more resources for physical education, it’s important to set realistic goals while allocating more

“IT WOULD REALLY BE VALUABLE TO VIEW PE AS A PUBLIC HEALTH TOOL TO EDUCATE STUDENTS AND EMPOWER KIDS SO THEY’RE ABLE TO PARTICIPATE IN ANY ACTIVITY THEY ENJOY.”

funds for future programs.

What’s Next?

Although it’s hard to find fans of middle-school swim PE, most readers can probably think of a pleasant experience associated with physical activity. Whether it’s going to dance classes at the RSF, playing intramural sports, or hiking the Fire Trails, there are plenty of ways to be active that don’t involve running laps on a track.

“Traditionally, in PE, there has been a focus on developing students into athletes,” explains Thompson, “but it would really be valuable to view PE as a public health tool to educate students and empower kids so they’re able to participate in any activity they enjoy.”

She lists topics like movement skills, increasing endurance, and teamwork that aren’t addressed in most K-12 PE curricula.

For a curriculum that does cover these topics, UC Berkeley students don’t need to look any further than their own PE Department, UCPE. Toni Mar, who teaches physical education at UC Berkeley, emphasizes the importance of the “E” in PE — providing a strong educational foundation for physical activity, based on biomechanics and kinesiology. Mar contrasted her unpleasant high school PE experience with her gym class in middle school, where she had a teacher that took time to explain both how and why to do certain exercises while making the classes enjoyable.

“If you enjoy what you’re doing, you’ll do it again,” she explained, and related that this is what she aims to do in her classes: explaining the why and how behind all activities and cultivating the motivation to learn and be active.

Kavya Nambiar, a senior at UC Berkeley explains that, in her experience with the UCPE department, the curricula value “learning correct and safe techniques, not just exercise for exercise’s sake.” The intentionality and robustness of physical education at Berkeley is a testament to the resources and faculty we have in the department — and to what PE should be like at schools everywhere.

“THE INTENTIONALITY AND ROBUSTNESS OF PHYSICAL EDUCATION AT BERKELEY IS A TESTAMENT TO THE RESOURCES AND FACULTY WE HAVE IN THE DEPARTMENT — AND TO WHAT PE SHOULD BE LIKE AT SCHOOLS EVERYWHERE.” While researchers like Thompson provide information to schools on what they can do to improve PE within their existing infrastructures, we as individuals can take the same approach to our physical education. For example, it’s not realistic for many college students to spend hours at the gym every day, but that doesn’t mean they should forgo exercise altogether. Nambiar relates that, as a college student, it was difficult for her to consistently work out at the gym.

She added that taking PE classes offered a way to build consistent exercise habits, recieve units for her time, and integrate physical activity into her lifestyle. It’s important to normalize exercise, as individual and group-level changes can lead to nationwide shifts in physical activity in educational, social, and public health contexts. We ought to examine what we can do to keep ourselves happy and healthy while doing what we can to ensure all Americans have the same chance of physical education and empowerment. 

ABOUT THE AUTHOR

Navya Pothamsetty is a senior majoring in public health. She enjoys dog-watching, live music, and Mezzo breakfast burritos. When she’s not writing for PHA, Navya teaches for the Health Service Internship Program and Peer Health Exchange. You can find her at Caffe Strada or hiking in Tilden Park.

THE PUBLIC HEALTH ADVOCATE | 15

ENSURING REPRODUCTIVE JUSTICE FOR ALL

Even though reproductive healthcare has come under constant scrutiny, college students are fighting for their voices to be heard.

BY AMY RICH 16 | FALL 2019

O

ur current political atmosphere is heated, and it is only getting hotter. A major political debate of today is access to healthcare, specifically reproductive healthcare.

The Supreme Court case Roe v. Wade in 1973 that federally legalized abortion was superficially an amazing feat in American politics and reproductive justice; however, making abortion legal in the United States exacerbated the pro-life or pro-choice debate, and the controversy continues to blaze in our current political climate.

It is clear that the fight for reproductive justice is under pressure — by passing the “gag rule” that dissuades healthcare providers from informing patients where they can access legal and safe abortion services, the Trunp administration limits patients’ access to complete information about their possible options. Despite the Roe v.

Wade decision that legalized abortion in our country, political figures with powerful authority and even more powerful opinions enforce the laws as they choose and find loopholes to work around laws that contradict their beliefs.

As the reproductive health debate slowly heats our country’s political atmosphere, however, nowhere is the topic more relevant than on college campuses. Many students argue that abortion services should be available at on-campus health centers. They

explain that, whether or not students are participating in safe sex, inconsistent use of or failure to use contraceptives can lead to high unintended pregnancy rates. In fact, according to the Wisconsin Financial Aid Study, 50 percent of college students on average have unexpected pregnancies, and this statistic correlates to increases in drop-out rates and decreases in future income. More than half of University of California and California State University students come from lowincome families, and therefore, they experience food and housing insecurity while on campus. Also, students who seek abortion services pay an average of $604. Considering these two facts, a lack of abortion care on college campuses can discourage or inhibit many students from obtaining the care of their choice due to the financial burden associated with abortion. Students who decide to go through with an abortion may face even more financial obstacles when an abortion provider does not accept their student or private insurance, when students choose not to use insurance in order to keep the procedure private, or when students do not have health insurance that covers abortion or do not have health insurance at all.

In addition to cost barriers, physical access can be limited. For example, offcampus abortion serivces are on average 30 minutes away by bus, one-way, and

“FIFTY PERCENT OF COLLEGE STUDENTS ON AVERAGE HAVE UNEXPECTED PREGNANCIES, AND THIS STATISTIC CORRELATES TO INCREASES IN DROP-OUT RATES AND DECREASES IN FUTURE INCOME.” only 15 percent of providers closest to college campuses are open on weekends.

As a result, students must adjust classes, exams, and work schedules in order to attend appointments, which can impair students’ academic performances. Even worse, after finding an off-campus provider, wait time for appointments is usually one week long, and this delay could disqualify a student from getting the abortion since the procedure can only be done up to the tenth week of pregnancy. The fact that people do not usually know that they are pregnant until two weeks after conception shrinks their timeline even more.

Without access to safe and legal abortion, people who want to terminate their pregancies must resort to unsafe practices that threaten their health and even their lives. People who undergo risky abortions or perform the procedure themselves are at risk of incomplete abortion, hemorrhage or infection, PHOTO BY LORIE SHAULL FROM FLICKR

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“NEWSOM’S SIGNATURE ON THE COLLEGE STUDENT RIGHT TO ACCESS ACT WILL ALLOW STUDENTS AT CALIFORNIA PUBLIC UNIVERSITIES TO TERMINATE PREGNANCIES WITH THE ABORTION PILL AT THEIR ONCAMPUS HEALTH SERVICES BY 2023.” and uterine perforation or damage to the genital tract caused when sharp, precarious objects like coat hangers, knitting needles, or broken glass are inserted into the vagina and pierce the uterus or other internal organs. Given the World Health Organization statistic that between 4.7 to 13.2 percent of maternal deaths can be attributed to unsafe abortion, access to abortion on college campuses can save the lives of students who do not have the resources to seek an abortion off-campus.

The College Student Right to Access Act is the California state bill that provides students access to medical abortion on college campuses.

Specifically, this bill makes the abortion pill available at university health centers.

The abortion pill safely blocks the body’s progesterone hormone needed for a pregnancy to grow and induces an abortion through uterine contractions and opening of the cervix.

The availablity of the abortion pill at university health centers will be a major victory for the overall fight for reproductive rights but an even more moving victory for the people on California college campuses that truly know best what they need. Students at UC Berkeley identified that the hurdles they already have or might have to get abortions are substantial, and they utilized their aggravations to advocate for access to the abortion pill on campus.

This small movement launched by a student reproductive health group on campus soon sparked a statewide movement called justCARE California

18 | FALL 2019

that mobilized students and allies among all California public universities to fight for reproductive justice. justCARE organized a rally at the California State Capitol where students, activists, and lawmakers listened to stories, speakers, and music in support of non-surgical abortion on public universities.

Erika Casey, a UC Berkeley alumna and former general member of a UC Berkeley club called Students United for Reproductive Justice, was one of the many UC Berkeley students that attended the justCARE rally at the Capitol. Casey explains that she joined the fight for medication abortion on college campuses because she believes “reproductive justice is a human and health right.” Growing up in a religious household, Casey was taught as a kid that abortion was wrong; however, her experience in college allowed her to realize that people who want an abortion will seek one out, so abortions must be safe, legal, and accessible.

“Male healthcare is never talked about in the same way [that abortion] is talked about,” Casey said. She makes clear that abortion is a contentious issue, specifically affecting politicians’ electability, and this causes abortion to be scrutinized, policed, and therefore eventually made illegal by politicians like Trump whose beliefs outweigh the reality of people’s healthcare needs.

However, following the fervent efforts of student activists like Casey, the College Student Right to Access Act was signed into law by Governor Gavin Newsom on October 11, 2019, which elevates California as the leader for reproductive justice. Newsom’s signature on the College Student Right to Access Act will allow students at California public universities to terminate pregnancies with the abortion pill at their on-campus health services by 2023.

Abortion service accessibility will immeasurably change the lives of students, but despite California’s accomplishment, the average American living in other states across the country can feel their reproductive rights escaping their grip. Trump’s “gag rule” makes family planning clinics

like Planned Parenthood ineligible for funding from Title X if they provide patients with abortion referrals. This means that family planning clinics will not receive federal funding if they refer patients to abortion services, which inevitably will eliminate safe and legal abortion options altogether as these services will not receive enough clients.

These ongoing threats to reproductive rights require an ardent fight for justice, and the student activists’ success with the College Student Right to Access Act sets the stage for the fierce fight that is only just beginning to provide people with their human rights.

Seen through the progress of this law, we catch a glimpse of the power mobilized, young students can have on the legislative process. UC Berkeley is known as the hub of large scale protests and movements, and we have seen through the history of our campus the impact passionate and driven students can have on creating change for political and social justice. Although Trump’s “gag rule” blocks access to safe and legal abortion care and makes many Americans worry about the fate of the Roe v. Wade decision, the College Student Right to Access Act shows us that we can use our fears as an impetus to take action. As young students, we have great potential to not only create the change our community needs but also rewire the reproductive justice that is unwinding in our country. 

ABOUT THE AUTHOR

Amy Rich is a second-year undergraduate student intending to major in Public Health and minor in Public Policy. She hopes to one day work in public health policy to fight for reproductive justice and disease prevention.

In her free time, Amy loves going to the beach, traveling to new places, going to concerts, spending time with friends and family, and going thrift shopping.

THE NEEDLE EXCHANGE PROGRAM CRISIS Bloodborne illnesses are spreading just as quickly as the stigma around them.

Needle exchange programs are trying to tackle both.

BY SUBEKSHA SHARMA

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I

t is no secret that bloodborne illnesses are an issue across the United States. It is also apparent how tightly these illnesses, most commonly HIV and hepatitis C, are linked with drug use. More than 25 percent of AIDS cases in the United States among those 13 and older are directly tied to injection drug use. In the last two decades, needle exchange programs have slowly become more prevalent across the United States, and they have been shown to significant impact bloodborne pathogens. Unfortunately, the lack of federal organization and the stigma surrounding these programs do not bode well for effectively addressing bloodborne illnesses.

Current needle exchange programs have shown to have an immense impact on rates of HIV transmission.

In New York, legalization of needlesyringe programs between 1990 and 2002 were attributed to a decrease in HIV prevalence from 50 percent to 17 percent. A CDC study also found that if the U.S. invested $10 million annually into needle exchange programs, 194 HIV infections would be prevented each year. Additionally, the government itself would benefit from these programs, receiving a lifetime treatment cost savings of $75.8 million. In other words, the government would receive a $7.58 return on investment for every $1 spent nationally.

The World Health Organization and American Medical Association acknowledge the effectiveness of these programs and assert that additional resources can provide motivation to pursue recovery, potentially reducing rates of illegal drug use. Joey Schemuel, a worker at the Berkeley Free Clinic’s Needle Exchange Emergency Distribution (NEED) program, wants

“CURRENT NEEDLE EXCHANGE PROGRAMS HAVE SHOWN TO HAVE AN IMMENSE IMPACT ON RATES OF HIV TRANSMISSION.” 20 | FALL 2019

the community to see that these programs have a multitude of benefits.

“Harm reduction works!” he said. “[Our programs] support the dignity, safety, and wellbeing of people who use drugs, and sharps containers that we distribute also provide a benefit to the community in decreasing syringe litter.” Many needle exchange programs, including NEED, refer people to treatment programs when they request it, but addiction treatment is not the main goal of their programs. “We’re always trying to create and maintain linkages with clinics in the community that provide evidence-based treatment for substance use disorders. …

We also can refer patients for primary care, HIV/HCV testing and treatment, mental health care, and other clinical services,” Schemuel said.

Although the implementation of needle-exchange programs has been shown to reduce rates of bloodborne illness, pushback from communities prevent these programs from actually being enacted. In Eureka, California, a harm-reduction program was implemented, but city council members have since expressed concern about divisiveness in the community surrounding the program. Constituents, too, are wary of needle exchange programs because they may believe the government is simply enabling addicts rather than helping them. Similarly, opponents believe that needle-exchange programs contradict efforts against the war on drugs, instead leading to a rise in drug abuse. Additionally, in order for these programs to exist, there must be accessible spaces in which these programs can happen. Community members often oppose the use of public areas for these programs, citing dangers for residents and children specifically.

In Berkeley, however, there is less opposition than in Eureka. According to Schemuel, “Most people, including many who don’t use our services are happy to see us out in the community.

The situation is much better here in Berkeley than in, say, Orange County, where the community managed to get the local harm reduction organization, OCNEP, shut down.”

“ALTHOUGH THE IMPLEMENTATION OF NEEDLE-EXCHANGE PROGRAMS HAS BEEN SHOWN TO REDUCE RATES OF BLOODBORNE ILLNESS, PUSHBACK FROM COMMUNITIES PREVENT THESE PROGRAMS FROM ACTUALLY BEING ENACTED.” Many are confused about the legality of needle-exchange programs as a whole. Although there once were laws banning the use of federal funding to support needle-exchange programs, the programs themselves are not illegal on a federal level. However, at the state level, there may be different regulations.

During the Obama administration in 2016, Congress lifted the ban on providing federal funding for needle exchange programs, a ban that had been in place since 1988. This legislation allowed for federal funds to be used for program expenses such as staff, substance-use counseling, and outreach, but not for syringes themselves. Even so, federal funding is incredibly useful — needles tend to be the least expensive aspect of needle exchange programs, and education coupled with treatment allows for more effective long-term solutions.

In his 2019 State of the Union address, President Trump announced an initiative aimed at eliminating HIV within 10 years. However, health departments in states like Maryland, which ranks fifth out of all U.S. states and territories in HIV diagnoses rates, have received no details about how this initiative would be implemented locally.

From the outside, it seems that the Trump administration is making strides to support the LGBT community and community healthcare. However, their failure to produce a proper plan for the aforementioned HIV initiative, coupled with efforts to reduce Medicaid and pass anti-LGBT legislation, paints a different picture. If anything, Trump’s statement

PHOTO BY TODD HUFFMAN FROM FLICKR

A STANDARD NEEDLE EXCHANGE KIT contains needles of different bore sizes, sterile water, cotton balls, alcohol prep pads, a small mixing pot, a tourniquet, and condoms. Multiple needle sizes are provided because drugs have varying viscosities.

“MOST NEEDLE EXCHANGE PROGRAMS ARE FUNDED ON THE COUNTY LEVEL, AND IT DOES NOT SEEM THAT THIS WILL CHANGE GIVEN THE LACK OF FEDERAL ACTION.” is nothing but a bandage to patch up a crisis requiring much more effort to resolve. Most needle exchange programs are funded on the county level, and it does not seem that this will change given the lack of federal action. For example, Berkeley’s NEED program hasn’t been touched by federal funding, but it does receive grant funding from the City of

Berkeley and Alameda County.

Although needle exchange programs have proven benefits, it may be harder than anticipated to convince the community to support their implementation. In order to tackle this issue at its core, the federal government needs to invest more time and resources into the implementation of effective programs in the regions that need them the most. Most importantly, Schmuel states, “we want people who use drugs to know that we see you, we care about you, and we are here for you.” 

ABOUT THE AUTHOR

Subeksha Sharma is a third-year from the Bay Area double majoring in Public Health and Molecular and Cell Biology. Outside of managing the print issue of PHA, she advocates for improved health legislation supporting minorities. After graduating from UC Berkeley, she hopes to pursue a career in reproductive healthcare. In her free time, she enjoys traveling, hiking and trying new recipes with her roommates.

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AMERICA’S MEASLES CRISIS AND THE ANTIVACCINE MOVEMENT The measles vaccine has saved millions of lives since its introduction in the 1960s. The spread of misinformation puts this progress in jeopardy.

BY RANEEM RAYES

I

n 2000, the CDC announced measles was eliminated in the United States due to a strong vaccination program and school mandates. Fast forward to November 2019, and we now have over 1,250 confirmed cases of measles since the beginning of this year, the greatest number of cases in the U.S. since 1994.

The prevalent anti-vaccination

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movement and other factors are partly to blame. Measles is the most transmissible virus known to man, with a high potential to be life-threatening. It is a human airborne disease, meaning it can be spread simply through coughing and sneezing and can remain suspended in the air for up to two hours. Currently, two doses of the measles-mumps-rubella

(MMR) vaccine is 97 percent effective against measles, making it the most powerful vaccine against any pathogen.

Before the measles vaccine was introduced in the 1960s, two to three million deaths occurred globally each year. Despite these statistics, many people today have been under the incorrect impression that it is a trivial

disease, contributing to the antivaccination movement. This is due to the fact that most people have never witnessed the debilitating and deadly diseases that vaccines protect against.

Another contributing factor is the vast spread of misinformation through unreliable media outlets.

This is not a problem of biomedical research, but rather a public health awareness crisis. Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases who has made significant contributions to HIV/AIDS research and has developed therapies for formerly fatal diseases such as polyarteritis nodosa, weighed in on this issue. He explains that when the level of vaccinations in a community falls below a certain critical level, a phenomenon known as herd immunity weakens.

Fauci best describes strong herd immunity as “even if someone enters into the community who is measles infected, the measles virus will have little opportunity to spread because most of the community is already vaccinated.” In a community, there are certain people with immunodeficiencies who cannot get vaccinated, thus making them highly vulnerable to diseases such as measles. The herd, which is the vaccinated population, protect the vulnerable ones from the spread of the virus. Approximately 93 to 95 percent of the population need to be vaccinated in order to create an umbrella of protection for this particular disease. Furthermore, since measles is seen throughout the world, we constantly have Americans traveling and bringing back measles into the U.S., making herd immunity critical.

“A CHILD WHO HAD VISITED RELATIVES ABROAD BROUGHT MEASLES BACK INTO HIS NEIGHBORHOOD IN BROOKLYN, CAUSING ONE OF THE WORST MEASLES OUTBREAKS THAT NEW YORK HAS SEEN IN DECADES.”

A weakness in herd immunity contributed to the recent measles outbreak in the Orthodox Jewish community in Brooklyn, New York.

The level of vaccination in that community was down to about 70 to 80 percent, well below the critical level of herd immunity, which was due to the spread of misinformation about the safety of the MMR vaccine among other causes. A child who had visited relatives abroad brought measles back into his neighborhood in Brooklyn, causing one of the worst measles outbreaks that New York City has seen in decades. A total of 654 individuals were infected, causing the city to issue a mandatory vaccination in people living in the four Brooklyn neighborhoods. This led to New York lawmakers creating a new state law in June, which revoked parents’ abilities to refuse immunizations based on religious reasons.

Failures in public health education and communication, the rise of the antivax movement, and even the declining measles rate as a result of previous measles vaccination success have contributed to more outbreaks. One of the main concerns of vaccination skeptics is the fear that the MMR vaccine is linked to autism. However, this link is a falsehood that has been debunked multiple times by the CDC and other health professionals. Despite this, Fauci states that the movement continues to exist because of the spread of misinformation through social media and extreme libertarianism. Health departments face the challenge of respecting individual rights and safeguarding the public welfare; therefore, many states allow immunization exemptions for religious and philosophical reasons. The problem with this “opt-out” system is that all parents have to do is simply check a box indicating they do not want their child to receive vaccinations.

As UC Berkeley students, we can help combat this issue by simply spreading knowledge in daily social discourse.

Nowadays, information is spread mostly through social media and many people do not fully evaluate the validity of internet articles. It is important to

“FAILURES IN PUBLIC HEALTH EDUCATION AND COMMUNICATION, THE RISE OF THE ANTI-VAX MOVEMENT, AND EVEN THE DECLINING MEASLES RATE AS A RESULT OF PREVIOUS MEASLES VACCINATION SUCCESS HAVE CONTRIBUTED TO MORE OUTBREAKS.” encourage media outlets to prioritize their search results. For example, Pinterest has taken down inaccurate content about immunizations on its platform, and Facebook has introduced a pop-up window connecting the user to the CDC or WHO when searching for vaccine-related content. Truth and evidence-based decision-making is integral to how many of us think; for that reason, we can promote the importance of vaccinations in discussions and social media when the topic comes up. We do not need a better vaccine, says Fauci. We just need people to get vaccinated. 

ABOUT THE AUTHOR

Raneem Rayes is a junior Public Health major with a minor in Data Science. In addition to writing for PHA, she works as a research assistant studying international health and violence against healthcare for Dr. Rohini Haar. She loves traveling, matcha, and kittens.

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