Journal for Domestic and Global Health
Volume I, Issue 1
TABLE OF CONTENTS
Letter from the E ditors Renán Orellana Jorge Zárate
!"#$%#&'(%"#$()"*+,-#."'/0-('" !"#$%&"'(!)%#"'*#+(*&(,$&+"( !"%+(,$%&(-(.#$*&/"%#(012( ( 345'*6(/$"'#/(*.(#/$("&.7$%(( *#8.(#*!$(#)(!",$("(9*::$%$&6$;( 9"!'"(<)&4''4(-(&+4("54(9/"5*(01=( ( He who has health has hope; and he who has hope has everything. (((((((((((((( - Arabic Proverb 1"*+,-#."*)-#.2" /$"'#/(%$:)%!(:)%("''(>(7/"#("5)4#(#/$(%$.#( ):(#/$!?( /$7$##(6/*4(-(6".(01=( We started toying with the idea of a public health initiative in May, following news of the 7"<&$%(012( development of the NYU Global Institute for Public Health. Since then our little idea has (( grown and morphed into a fully-fledged journal as more people from diverse fields of #/$(3%*.)&(.+.#$!("&9(*#.(%$'"#*)&(#)( 6)!!4&*6"5'$(9*.$".$(3%$.$&6$(*&(#/$(4&*#$9( studies jumped on board. Much like our journal, Public Health as a discipline also started .#"#$.( small. ,"#*$(&)'"&(-()3$%"#*)&.(6))%9*&"#)%( ( ( It all started with Hippocrates, who was on the right track when he postulated that disease 33"/.)$)4#.%"5"6/7/-)*4/$(" 5$+)&9(#/$('*</#.(*&(#/$(6*#+():('*:$@(*&6)!$( wasn’t a punishment from the irascible gods but rather had an earthly cause. Anton van *&$A4"'*#+(*&(/)&<(,)&<( Leewenhoek built on this notion when he was able to describe microorganisms with the ./$%*&"(!)#7"&*(-(<')5"'($6)&)!*6.( 6)'4!&*.#( help of a microscope as early as 1680. It took us a couple of centuries – or 18 – to drop " Hippocrates’ humoral theory of disease in favor of the germ theory. In part, we have John " 3!",#)4/6#.0-"5"-#8/"%.#/$./%" Snow to thank for that, who went knocking door-to-door to prove his theory that cholera 6"&(5"6#$%*"(!",$(+)4(:"#?( infections were related to the water people were drinking upon discovering that the nearby B)%<$(CD%"#$(-(6)E$9*#)%E*&E6/*$:( ( cesspit had been leaking fecal matter into the Broad Street water pump, a water source 3%*)&.@("('*&,(#)("'C/$*!$%.( ./$&<*$(B*(-(6".(01F(( frequented by many of the sick people in the cholera outbreak. Thirty years later, Robert ( Koch was able to isolate the culprit: Vibrio cholerae, and the rest is history. ( 31"&-),0-"$/(9):;"+$#7/:%#(2" !"'"%*"(*&(</"&"@(<"*&*&<(*&.*</#()&( Today, Public Health focuses on chronic ailments rather than on infectious diseases since, ,&)7'$9<$G("##*#49$.G("&9(5$'*$:.(#)7"%9( it is diabetes that kills more children than smallpox, and heart disease that kills more !"'"%*"(H$6#)%(6)&#%)'( 6/+#"&+"(,)!3"'"G( adults than cholera. Our industrialized world faces challenges that require investigations 5)&&*$(!"6'$)9(-(.#$*&/"%#(01=( far more comprehensive and complicated than hunting down a soiled water pump – no ( ( offense to John Snow. It requires a multidisciplinary approach that identifies the diseases !3"*:)8/%%#)$0-"*/:%*/.(#7/%" of the 21 st century as not merely caused by a single agent. In order to piece together ((((((((((/*HI("*9.($3*9$!*6( (((((((((((((B)/&(/$''!"&G(!J"J( solutions to alleviate today’s most widespread afflictions and health problems, we need to 9*%$6#)%():("9H)6"6+( understand the socioeconomic background they arise in, internal factors like genetic (((((('"#*&)(6)!!*..*)&()&("*9.( ( predisposition and external ones like air pollution, as well as risk behaviors, income ( distributions and of course, the nature of the pathological agents and the natural progress !<"'+40$":#&'(%"5"%).#0-"9/-80:/" .6/)'"%'+($K3')%"#*)&(*&($'(5"%%*)( of infectious diseases. "&9%$(!"%.#)&(-($946"#*)&(6)''"5)%"#)%( ( #/$(L:*.#$9(/"&9(.+&9%)!$M@(')),*&<("#( In short, with healthcare always in the news and the national average weight rising, Public 9)!$.#*6(H*)'$&6$(:%)!("(345'*6(/$"'#/('$&.( Health has risen to prominence. We hope this publication will serve as a platform for the %$&D&()%$''"&"(-(6)E$9*#)%E*&E6/*$:( ( NYU community to exchange innovative ideas and share research in the myriad of ( disciplines that comprise Public Health, allowing our community to start a conversation to =!"*/:%)$0-"'/0-('"5"9/--$/%%" (&$7(.6/))'(+$"%(%$.)'4#*)&.@(,$$3(.#%$..( produce novel solutions to the problems that burden us at the domestic level and (in true '$H$'.(9)7&( GNU fashion) the world as a whole. %*6/"%9(/.4(-(:*#&$..(N(/$"'#/+('*H*&<( 6)'4!&*.#(( (
Student Insight on Maternal Health in Kenya Mary Kern, NYU Steinhardt 2015 Public Health, Social and Public Policy, and Anthropology I never thought that maternal and women’s health would be my passion within the realm of public health. I guess you could say it chose me...or splattered on me, rather. This past summer, I had an incredible opportunity to live in Kenya for approximately six weeks, assisting in a hospital in rural Kijabe, tucked away in the Great Rift Valley. One of my first evenings at Africa Inland Church Hospital, my host, a surgeon at the hospital, brought me down to the delivery room to observe a birth. I had never seen a live birth before; my only exposure had been the very dated film, “The Miracle of Life”, shown to me by disinterested P.E. teachers in health class. With quick Swahili orders flying all around me, I entered the delivery room/maternal wing where two women were in active labor while ten were in early labor: a happening place for only one midwife and a couple student nurses! Labor was progressing quickly for both women, so the midwife took care of one woman and asked the surgeon and me to step in for the other. Before I knew it, I was holding a squirming newborn in my rookie hands as the surgeon took care of the umbilical cord. Blood and amniotic fluid covered my street clothes and TOMS shoes, but I did not care. With a giant grin on my face as I saw the look of sheer wonder on the mother’s face, I realized that this was the most incredible experience I had ever been a part of—something I would love to continue to be a part of.
Public Health Is the Answer It’s T ime to Make a Differen ce! Damla Gonullu, NYU Abu Dhabi 2014 Social Research & Public Policy I spent my whole life in hospitals with doctors, nurses, and medical students. This encouraged my passion for the health sciences, and my desire for helping others. I explored almost all of the career options in the field while spending time with physicians and health personnel from different departments and backgrounds. However, public health is a field I have only recently been exposed to. Public health is different than any other medical field in the sense that it is vital to everyone at any time. It is life changing for millions and billions by providing the necessary conditions for the healthy living of the community as a whole. The importance of public health is sadly not highlighted in my developing home country, Turkey.
This summer when I returned to Turkey, I decided to explore what is going on in terms of public health within the country. First, I talked to a few family friends who are physicians and their reactions were cold when I
told them I had an interest in public health and that I wanted to explore how Turkey approaches its current public health issues. Then, I talked to current medical students of Ankara University School of Medicine and asked them if they were interested in specializing in public health. One student responded, “Well if you don’t want to make any money go and get a specialization in public health, but I am more than interested in making a tonne”. Then, another student added, “To me, public health classes are the easiest to get good grades in...It’s not complex enough for me to have a desire towards it”. Putting together all of the responses I got from the current medical students in Turkey, I realized that public health is one of the least desired specialties that medical students really care about, at least here in a developing country which ironically is in need of a revolution in public health. Sadly, the majority of medical students use their education soley to help individuals who pay for their services rather than help the population with their public health issues as a whole. My last step was to go talk to Professor Banu Cakir M.D., MPH, from the best public health institute, Hacettepe University Institue of Public Health, in the capital city of Ankara. Professor Cakir was very well educated and experienced in the field, and also was the first person who helped me to affirm my passion for public health. Her general view about Turkey’s approach to Public Health was also not very positive however.“It’s all about the economy. In Turkey only developments towards public health are made when a lot of money is lost for health services, then the government temporarily realizes that treatment of individuals is very costly and not very efficient.”, said Professor Cakir. In other words, rather than trying to treat groups of individuals who are suffering from similar problems that we know the causes of, Turkey should have more of an communal approach that goes through education, research towards the causes, and promotions of healthy lifestyles. That way efficiency of the health services would increase, and less money would go to waste. After having a wonderful conversation with Professor Bakir, an expert on public health in Turkey, I decided to do a little research. Through the official webpage of the Turkish Public Health Institute, thsk.gov.tr, I have found that the main causes of the health problems that millions face in Turkey are as follows; smoking, obesity, malnutrition, and polluted water sources. Then I thought to myself; wouldn’t it be easier to educate the people about healthy nutrition and drug abuse through promotions rather than to treat each and every one of them with expensive procedures? Wouldn’t it be better to give more significance to public health so that we could find sustainable solutions to these health problems? I think it is time for the youth of our world, especially the youth of the developing countries, to open their eyes and see that the answers to many health problems of the developing world lie in the field of public health.
Health Reform for All - What About the Rest of Them? Implementing Health Reform for Undocumented Immigrants Hewett Chiu | NYU College of Arts and Sciences 2014 Wagner Graduate School of Public Service 2015 With the Patient Protection and Affordable Care Act of 2010 (“ACA”) passing Supreme Court scrutiny and declared constitutional in June 2012, all U.S. citizens and “lawfully present” aliens as described by the ACA will be required to purchase health insurance. While this will help the many current Americans who are left without adequate health insurance and aims to patch up the traditional “donuthole” left by the current healthcare system for the underinsured, the ACA is not the ultimate solution to addressing our healthcare needs. There are still certain individuals who are not covered, or to whom the ACA does not apply. Chief among these groups are undocumented immigrants. While the recent deferred action initiative opens doors for illegal immigrants to continue residing in the country, the influential and groundbreaking ACA does the opposite - barring these groups from partaking in the law’s new enactments, effectively preventing them from accessing affordable health insurance. At the heart of the ACA is the individual mandate the provision that aims to bring affordable health insurance options to every American. The mandate requires each American citizen to be enrolled in a health insurance plan, or face a tax penalty which would be collected by the Internal Revenue Service. To help facilitate this, the act calls for the creation of state-based “health insurance benefit exchanges”. These exchanges serve as an open marketplace for individuals to search for and enroll in a plan that fits their needs. For insurance carriers, the exchanges provide a competitive vehicle to promote their products to specific segments of their market. To help guide individuals through the web
of health insurance intricacies and help facilitate searching for and enrolling in the best fitting plan, the law also calls for the designation of “navigators”. Navigators will be specific predetermined and screened community organizations, government agencies, or private entities (such as brokerage firms) who will go through a certification process to walk individuals through the exchanges . While it is evident that our federal government is taking significant strides towards bringing healthcare to every American with the exchanges, undocumented immigrants still face the same problem with health access as they always have. The legislation does not allow undocumented immigrants to partake in the exchanges or any other part of the law, and thus, there really is no reform in healthcare for this population. This being the case, what can we do to better serve these immigrants, and ultimately, improve the dynamics of our healthcare system? CURRENT MEDICAL CARE OPTIONS It is true that there are still some options for an individual who needs medical attention but is not documented. For example, the Emergency Medical Treatment and Active Labor Act (“EMTALA”), passed in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act (“COBRA”), stipulates that all federally recognized hospitals and healthcare centers must, at a minimum, provide a full screening by a qualified healthcare professional, stabilize the patient’s condition, and make transportation arrangements for the patient to
another facility if the current facility cannot admit the patient as necessary. Hospitals not abiding by EMTALA risk losing their federal funding, which may account for a great portion of their overall annual operating budgets . Besides EMTALA, immigrants can also receive full Medicaid eligibility without having all their paperwork finalized under the Permanently Residing Under Color of Law (“PRUCOL”) eligibility criteria. PRUCOL is not a citizenship category, it is merely a classification of eligibility for specific immigrants who may not be properly documented, but are residing under the knowledge or acquiescence of the federal government and the government has no plans of deportation for the individual. Having been tried in court on a federal level, PRUCOL was effectively banished by the passage of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, placing severe limits on state and local governments as to what welfare opportunities undocumented immigrants are eligible for. Having been challenged by the states, many state and local governments now define PRUCOL eligibility for those who reside within their jurisdiction. Once an immigrant is considered PRUCOL, he/she will receive all benefits as any other citizen covered under Medicaid. For someone who does not fit the criteria for PRUCOL, there are still options to receive a wide range of care. Local governments are charged with providing a safety net health system for those who cannot afford the price of healthcare, but really need it. Many of these safety net systems are openly blind to documentation, and vow to treat and admit any patient who walks through its doors regardless of immigration status or financial situation. In addition, many private and not-for-profit hospitals are also blind to documentation and seek to treat the uninsured and underprivileged. These hospitals factor in uncompensated care into their budgets each year, knowing that they will not be reimbursed for a certain amount of care that they will provide during the year. To help alleviate these charity care expenses, many of these hospitals receiving federal
funding as a disproportionate share hospital (“DSH”) to help adjust for the greater portion of uncompensated care they provide. CLINICAL, SOCIAL AND ECONOMIC CONSIDERATIONS Even with EMTALA, PRUCOL, and DSH funding, not involving undocumented immigrants in the current healthcare system would be detrimental to the system as a whole. The ACA calls for a significant reduction in DSH funding in favor of Medicaid expansion . However, reducing this funding can contain costs only if those who seek to participate in the healthcare system can enroll in Medicaid. Undocumented immigrants are not given this option aside from receiving state Emergency Medicaid under certain circumstances. This translates to immigrants continuing to visit emergency rooms for medical care, even for non-emergency related matters. Because our healthcare system already opened the doors for EMTALA, PRUCOL, and uncompensated care, immigrants who have no place to go for regular health care will visit emergency rooms and continue crowding the emergency department for health needs, where they know they will be seen. However, from a social perspective, doing so would mean they are taking up the space of someone else who would really need the attention and care of the emergency department potentially more than they would. From a clinical perspective, this usually means that these patients let diseases and conditions manifest to such a state that they cannot bear it anymore. This usually means a higher cost of treatment with worse rates of outcomes than if they had sought preventative care and services (another improvement called for in the ACA which they do not have access to) at the onset of the symptoms presenting. From an economic perspective, they will be visiting one of the most resource-intensive departments of a hospital for care that they can seek faster and outside for a lower price. The emergency department
continually needs to be stocked appropriately for a full range of conditions to be treated, which raises the cost of the maintaining that facility. If these immigrants were able to seek care like any other American, they can easily visit a local clinic as soon as they are ill or injured, which translates to lower medical costs, faster medical attention, better outcomes, and lower stress and frustration. In addition, immigrants typically represent a lower socioeconomic status (“SES”) than other Americans. If this is the case and they will still continue to visit the very health centers that our system has to pay for without letting them partake in the system, we still continue to bear much of the burden of cost for their care in the end. SOCIAL CONSTRAINTS Given a choice of whether or not to have good health, anyone would presumably choose to be healthy. However, in real life, it is not so simple. There are certain factors that may predispose an individual to negative health conditions, and immigrants are especially prone to these limiting factors. One particular factor is an individual’s socioeconomic status, which considers the income, occupation, and education of that individual. These three elements interact and are dependent on each other to determine a person’s health status. For example, an individual’s lower education may lead to a less lucrative occupation, which in turn leads to lower income. With lower income, that individual is less likely to have adequate health coverage and certainly fewer resources to pay for medical care when needed. This leads to individuals who cut back on their healthcare costs, which in turn produces patient noncompliance to filling and taking their medications on time, deciding to undergo certain necessary procedures, or even seeking timely healthcare.
Occupation also plays several roles in determining one’s health status. A person’s occupation may provide health insurance for their employees and their families, and thus may lead to better health outcomes. In addition, the amount of stress experienced by a worker also contributes to overall health. Continuous stressful jobs or jobs that do not produce enough income for a family may lead to toxic stress which can eventually contribute to permanent organ failure. Immigrants are more likely to work in blue collar, physically demanding jobs and thus, would experience higher levels of toxic stress daily, coupled with the fact that many of these blue collar jobs do not offer health insurance to their laborers. Many of these limiting factors stem from the lack of proper higher education for immigrants. Without advanced education, it is more difficult for individuals to acquire a secure, well-paying job with excellent benefits. In addition, a lower education also means lower understanding or comprehension of certain concepts and principles, and thus immigrants with lower education are less likely to understand diseases, what they can do, and proper management of their health conditions. This in turn further contributes to patient noncompliance and an overall costlier healthcare system when providers must spend time educating patients and translating instructions into the immigrant’s native language. MOVING FORWARD To address the different factors affecting the health status of undocumented immigrants, three priorities should be considered: Improve health literacy among immigrant populations. Health literacy is a central contributing factor to many health concerns and can account for a good number of immigrants not seeking timely care. Being able to understand different diseases, treatments, and methods of caring for various
conditions may greatly impact the quality of life of someone living with a certain disease. Raising awareness of the prevalence for specific diseases and the need for regular and periodic health screenings is an excellent prevention tool for those who do not know whether they have a certain condition. To improve the health literacy in any highly saturated immigrant community, grassroots outreach efforts need to be made consistently and aggressively. Community organizations and boards built into the foundation of each immigrant community should consider implementing a weekly or biweekly seminar series that is free and open to the public, presented in the languages predominant in that community and lasting only one hour. Each seminar can concentrate on a different disease or condition, with first explaining in simple vernacular the signs and symptoms and the common clinical manifestations of that disease, followed by the necessary follow up and common treatment methods available. Each seminar should end with a â€œTake Action Nowâ€? segment, highlighting screenings or other services an individual should seek to help with that condition. At the end of each seminar, the facilitators should make themselves available to answer any personal questions from community members, and should be ready to make proper referrals to community health centers as necessary. These seminars may run on a rotating schedule such that if a community member cannot make one on a certain day, another seminar on the same topic will be available in the near future. Promote healthy behaviors in the daily lifestyles of residents. With higher rates of uncontrolled health conditions within undocumented immigrant populations, a need arises to address not just treating the disease, but proper long-term management of the health condition such that the condition does not excessively worsen or the condition does not precipitate in an otherwise healthy individual. This would require each individual to understand and practice healthy social behaviors and make positive, healthy lifestyle choices long-term. However, the lower education rate within this population usually
contributes to a more physically and/or mentally stressful occupation with a lower income; and habits such as healthy eating with fresh fruits and vegetables and exercising are not common or affordable. Enacting this proactive intervention utilizes a multi-faceted grassroots and integrative approach. From one perspective, local healthcare organizations may implement a regular free public hands-on workshop to coincide with the seminar series mentioned above. This hands-on workshop would be a weekly hour of guided exercise, relaxation, and stress reduction techniques similar to classes found at a costly gym or health club. Providing access to such services and at such a regular interval would ensure that community members have a long-term solution to maintaining an exercise regimen and reducing stress that may otherwise become toxic. From another perspective, the local community boards should consider working with local not-forprofit food pantries who give out foods and vegetables to the underprivileged. The community board can implement a nutrition program at such pantries to ensure that fresh produce are being used and distributed, and healthy methods and alternatives are being used to prepare meals. In addition, the community board can co-host cooking demonstrations on-site at these food pantries, showing community members how simple and fun it is to cook healthy. Finally, local organizations can also make substance abuse, smoking cessation, and alcohol dependency counseling programs free, open, and readily available to community members. Each of these programs targets the leading social behaviors leading to many of the leading health disparities seen today, especially hypertension and cardiovascular diseases. These programs should be available in the predominant languages in that community, and guided by facilitators and counselors from the same ethnic and cultural
background as residents. This ensures that there is a degree of understanding and trust between the resident and the counselor such that residents would not shy away from seeking assistance to cease unhealthy habits and behaviors. These organizations should also engage in mass marketing and dissemination of information about these programs to reduce the stigma they currently face in society. Develop an integrated network of culturally oriented community health centers working together and coordinating medical care and health outreach efforts. Because of certain language barriers and providers who do not understand cultural values within health centers, many undocumented immigrants feel unwelcome or afraid of seeking healthcare when they need it most, being frightened of having to explain their condition to a stranger. It is therefore necessary to have culturally competent community health centers located within the core of immigrant communities staffed by professionals who hold the same values, speak the same language, and understand the same cultural practices of the immigrants they serve. These community health centers should be a place where residents are not afraid to seek out healthcare. Local community boards can develop a process to guide community centers to become navigators for the new state health insurance benefit exchanges under the ACA. In addition, these community centers should be able to work together and not compete against one another. The community boards can develop a community “Shared Health Record Database”, an Electronic Health Record system in line with Meaningful Use  criteria that spans the network of culturally competent community health centers. This allows each resident to be able to visit a community health center for follow up, specialty services not offered at another center, or just for a second opinion, and not have to worry about transferring prior medical records and duplication of efforts leading to excessive testing and a waste of resources. Integrating efforts across such centers also allows for stronger and wider outreach and education efforts
from the provider perspective, and a more solid system of care rooted in the community it serves. CONCLUSION While the current state of health reform effectively prevents undocumented immigrants from accessing the healthcare they need, there are still options for implementing health reform to meet the needs of this group. From analyzing the dynamics of how undocumented immigrants affect the healthcare system that we all partake in, even if they are barred from participation themselves, we begin to see that neglecting undocumented immigrants may very well still drive our healthcare costs up and lead to higher rates of illnesses and diseases within our society. Thus, by proactively developing an understanding of the backgrounds of these immigrants and the specific situations they face, we can truly begin to enact a healthcare reform model that can be implemented at the community level to improve the health and wellbeing of everyone in society.
Hewett Chiu is currently in the joint-degree B.S./M.P.A. program, studying Neural Science and pre-medicine in CAS and Health Policy, Management & Finance at NYU Wagner.
Sources:  http://healthreform.kff.org/the-basics/Requirement-to-buy-coverageflowchart.aspx  http://www.healthcarereform.ny.gov/health_insurance_exchange/docs/wa kely_role_of_third_party_assistors.pdf  Zibulewsky J. The Emergency Medical Treatment and Active Labor Act (EMTALA): what it is and what it means for physicians. Proc (Bayl Univ Med Cent) 2001;14(4):339–346.  Public Law 104–193—Aug. 22, 1996 110 Stat. 2105  http://www.healthcare.gov/law/resources/authorities/section/1203disproportionate-share.pdf  http://www.healthit.gov/policy-researchers-implementers/meaningfuluse
The Prison System and Its Relation to Communic able Disease Presence in the United States Katie Nolan | Operations Coordinator ! The prison system in this country is nothing short of problematic and broken. At year’s end in 2010, there were 1,612,395 prisoners in both state and federal correctional facilities; this worked out to be a rate of about 1 prisoner in every 200 residents [i]. These are some of the highest rates of imprisoned people in the world, and they come at a cost for the prisoners, the community and the criminal justice system itself. “Offenders sent to prison enter a complex social world of values, rules and rituals designed to observe, control, disempower and render them subservient to the system,” and often this “subhuman” ideology portrayed onto the prisoners results in maltreatment to a cruel and inhumane extent [ii]. As the Stanford experiment of 1971 describes, there is a natural tendency for prison guards to treat prisoners in an inhumane manner, and the system of checks and balances to protect inmates are virtually non-existent. In the United States, it is not uncommon to find prison facilities overcrowded and scant of basic hygienic necessities, creating the perfect breeding ground for infectious diseases to prosper. Many detention facilities have become so overcrowded, in fact, that they have resorted to a process known as “cell doubling,” where inmates are placed in cells with twice the occupancy as the prison capacity suggests. Although this process may seem to constitute as a “cruel and unusual punishment” that should be obstructed by the Eighth Amendment, the Supreme Court voted to uphold these detention facilities’ decision to overcrowd the already small living quarters of inmates in 1981 [iii]. Currently, there is no federal requirement that controls the density of inmates in correctional facilities. With so many inmates occupying so little space, there comes an increased chance of activities that could result in the spread of many infectious diseases, such as razor sharing, exposure to used needles (through illegal tattoos, drug use, etc.) or sexual contact, whether consensual or non-consensual.
The Center for Disease Control and Prevention (2003) finds that the hepatitis B virus is of great significance when considering the spread of infectious diseases and the role the U.S. prison system plays in it. The hepatitis virus is transmitted through blood, semen and vaginal secretion. Thus it is a virus that is easily spread through sharing instruments that may have contact with blood such as razors, tattoo equipment, and needles used by injection drug users, or through sex—all activities that can be found in correctional facilities, especially those with such a high density of inmates. It is estimated that a staggering 1.0-3.7% of U.S. inmates are chronically infected with the virus— which is a prevalence rate two to six times higher than the national prevalence [iv]. This high prevalence of hepatitis B is particularly troubling due to the increased risk of liver disease, damage and scarring, and subsequently, mortality and morbidity. Even more troubling, perhaps, is the high rate of tuberculosis in American prison systems. Tuberculosis is an airborne disease caused by the M. tuberculosis bacterium that usually targets the lungs, causing such symptoms as fatigue and coughing up blood, among other things. If TB is left untreated, it can be fatal. It is suggested that the correctional facilities in the U.S. have an alarmingly high prevalence of TB due to the infectious nature of the bacterium. Because it is spread through the air, one highly infectious person can infect any other person that occupies the same air space, which may be a drastically large number due to our problem of cell overcrowding. The CDC estimates that although only 0.7% of the total U.S. population was incarcerated, inmates accounted for 3.2% of all TB cases nationwide [v]. It can be inferred that this high prevalence as well as the high prevalence of HIV/AIDS in the nation’s prisons can actually be due to the vicious cycle in which the victims of either of these diseases are placed. HIV/AIDS and TB are co-morbidities, meaning that patients who test HIV+ are far more susceptible to contracting TB. And with HIV rates so high in inmate populations due to activities associated with high densities of people such as increased sexual contact and the exchange of dirty needles, we can be absolutely
certain that these are of a huge concern to public health. It was estimated that in 2005, 1.7% of the federal inmate population was diagnosed with HIV/AIDS and .4% were confirmed cases of AIDS, compared to the national averages of .31% and .15%, respectively [vi].
implications to the community and familial structures will be highly diminished. Once incarceration rates are lowered, this may also help to alleviate the issue of overcrowding in prisons. Thus, there would be less contact with other prisoners that may lead to the spread of disease.
These health issues that inmates are facing within our countryâ€™s correctional system are far from isolated. The high rates of communicable diseases in these environments impact the entire country, all communities and families. Recidivism rates in the U.S. are also extremely high, and most inmates at any given time can expect to lead a life that entails living between prisons and the free world. During 2007, it is estimated that over a million persons that were on parole were also at risk of reincarcaration.[vii] The continuous exchange of people from prisons to their communities at such high rates can be detrimental if they are carriers of a communicable disease, and worse, if they are highly infectious. Parolees risk infecting family, friends and any person or body that may come into contact with their direct social network. Thus, the high rates of these diseases in prison systems may threaten the health of an entire unknowing community.
The second tier would focus on a secondary preventative action to avoid the spread of infectious disease. Preventative efforts need to be enforced in our prison systems. Knowing what we know about the disease burden of this community, we need to act and respond to this emergency. Prison systems need to not only offer counseling for disease prevention, but adequate treatment and medical attention to those who are infected. By incentivizing inmates to seek medical attention and get tested regularly for these conditions, we could treat them and thus render them less infective, alleviating the spread of disease among the population. Simply because the incarcerated population in this country seems to be distant and secluded from the country as a whole, it is important to also consider their burden as our own.
Rather than preventing inmates from returning to their lives and families, I suggest that we put into place a two-tier system that prevents the spread of infectious diseases, namely HIV, TB and hepatitis, throughout the prison system and throughout communities. As a type of primary prevention, we should attempt to bring down the number of people that are sentenced to incarceration in this country. As the U.S. has some of the highest levels of incarcerated persons in the world, we need to begin to consider ways to lower the amount of people that are put into jails to begin with. Perhaps we may find that many people who are being placed into prisons could actually be better served through social services, such as counseling, or through milder punishments such as community service. The other advantage of this idea is that by allowing criminals to retain their autonomy, the social and financial
[i] The U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics. (2011). Prisoners in 2010. Retrieved from http://bjs.ojp.usdoj.gov/content/pub/pdf/p10.pdf [ii] de Viggiani, N. (2007). Unhealthy prisons: exploring structural determinants of prison health. Sociology of Health & Illness, 29(1). Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/j.14679566.2007.00474.x/pdf [iii] Rhodes v. Chapman, 452 U.S. 337 (1981). [iv] The Center for Disease Control and Prevention. (2003). Prevention and Control of Infections with Hepatitis Viruses in Correctional Settings. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5201a1.htm [v] The Center for Disease Control and Prevention. (2006). Prevention and Control of Tuberculosis in Correctional and Detention Facilities: Recommendations from the CDC. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5509a1.htm [vi] The Foundation for AIDS Research. (2008). HIV in Correctional Settings: Implications for Prevention and Treatment Policy. Retrieved from: http://www.amfar.org/uploadedFiles/In_the_Community/Publications/HIV%20In%20Correctional%20Set tings.pdf [vii] The U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics. (2012). Recidivism. Retrieved from http://bjs.ojp.usdoj.gov/index.cfm?ty=tp&tid=17
Beyond the Lights in the City of Life: Income Inequality in Hong Kong Sherina Motwani | Global Economics Columnist NYU College of Arts and Science 2014 ! ! When people hear the word ‘poverty,’ they immediately envision suburban slums in a third world country. Home to the freest economy in the world, Hong Kong never comes to mind. Although true to its reputation, Hong Kong is an industrialized city that thrives on capitalism, almost a million people in Hong Kong live below the poverty line. According to a recent article in Business Insider, New York City scored 0.5 on the Gini Co-efficient, a scale that measures inequality from 0 (complete equality) to 1 (complete inequality). Hong Kong scored 0.535, and is the most unequal developed city in the world. The leading reasons behind Hong Kong’s inequality may come as a surprise to many economists, as they step outside the typical explanations such as gender inequality in the workplace and low education figures. Although both of these reasons are contributing factors, the social structure of Hong Kong is primarily at blame. Ethnically, more than 90% of the population is Chinese. The remaining residents include a number of wealthy expats, who rarely integrate themselves into the local culture, and fail to witness the poverty that surrounds them. However, even more significant are the foreign domestic helpers (FDHs). As FDHs reside in the city without HKID cards, they not subject to local rules such as the HK$28 (~US$3.60) per hour minimum wage. Dolce, a Filipino foreign domestic helper in her mid-40s, is paid a mere HK$3000 (~US$387) per month to be on call 24 hours a day. As a live-in maid, her position includes free room and board, but her low salary is still shocking by developed country standards. Conversely, but equally shocking, is the high !
purchasing power of visiting tourists from Mainland China. According to the Hong Kong Tourism board, these individuals make up the largest percentage of the visitor source market of Hong Kong, with 28.1 million arrivals in 2011. With overnight visitor capita spending at HK$7333 (~US$945), these tourists contribute significantly to Hong Kong’s GDP. Large luxury brand stores such as Louis Vuitton and Coach can be found all over the city, and high end shopping mall IFC has enjoyed steadily increasing traffic since the opening of its 2-story Apple Store last year. This stark contrast in wealth is problematic, as rich tourists drive up prices for local consumers beyond affordability. To add insult to injury, Hong Kong is one of the most densely populated cities in the world. According to BusinessWeek, property prices have reached levels not seen since 1997. Although the newly appointed Chief Executive Leung Chun-ying hopes to regulate this worsening problem, it will be a difficult task to achieve – the current demand for housing in Hong Kong far exceeds supply. Hundreds of desperate individuals have taken up residence in ‘coffin homes,’ tiny 15-square-foot compartments that fit nothing more than a twin sized bed. Hong Kong’s dirty little secrets are being exposed one by one, and the hidden misfortune under the glamour of the city could eventually be the source of political unrest. Although Hong Kong was late to the Occupy Wall Street party, the first protests ringing out almost a month after the movement began in New York, the Central financial district should potentially prepare itself for more local outrage in the future. The Hong Kong government and times are changing, and hopefully these changes are for the better - but only time will tell. Until then, corporate expats will continue to luxuriate in their high-rise apartments, while many less fortunate individuals, insignificant specks in the distance, look on wistfully from the streets.! ))!
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Can Bacteria Make You Fat? Jorge Zárate | Co-Editor-in-Chief We’ve all heard by now about the epidemic spread of obesity in the United States and the world. While only twenty states in the US had obesity prevalence rates of 15% in 1989, not a single state remains with such low rates today – in fact, at least 20 states have rates higher than 30%, according to the Center for Disease Control. An increasingly sedentary lifestyle, increased portion sizes, improvements in technology, and the growing demand for processed foods all share the blame for the increased prevalence of obesity, but there’s another main contributor: bacteria. The link between bacteria and obesity is not completely understood. Bacteria, we believe, affect the efficiency of digestion either by compromising the integrity of the intestinal lining (increasing the amount of nutrients and fat that cross into the bloodstream) or via the production of byproducts, like certain short chain fatty acids, that allow us to yield energy that would otherwise be wasted. Entire ecological systems of microorganisms (microbiome) live on us; the skin, mouth, gut, and genitalia each have their unique microbial communities. For every one of your cells, there are ten bacterial cells living in and on your body. Research is starting to show that these bacteria play very important roles in the normal functioning of the body. For example, some bacteria are known to “train” the immune system to recognize harmful bacteria and prevent infection. The bacterial communities that we coexist with are very dynamic – their compositions not only vary depending on what part of your body they chose to colonize, but also change depending on your age, the season, and even your lifestyle choices, such as what you eat and whether you smoke. The bacteria in the gut are particularly sensitive to your diet, since different bacteria prefer different nutrients as sustenance. The research I was part of this summer as part of the Blaser Microbiology Lab at NYU’s Langone School of Medicine focuses on the microbiome that lives in the gut. The microbiome of the gut develops as we age, and the body naturally selects for the bacteria that will become part of the adult microbiome, which
can influence adult metabolism. The bacteria our bodies select for depends on several factors, including our diet and our genetic profiles. The natural selection process can also be disrupted by antibiotics; farmers have been using low-dose antibiotics to fatten livestock since the 1950’s. We do not know yet, however, how antibiotics change these microbial communities, and which microbes could potentially promote or prevent weight gain.
Advancements in technology have provided additional tools, like high-throughput DNA sequencing, that will help us to better understand the microbiome. High-throughput sequencing is a fast method that allows us to examine the composition of microbial communities in hundreds of samples at once. The DNA sequencing machine works by reading the amount of light emitted each time a base (A, T, C, or G) binds to a single-stranded DNA sample – this chemiluminescene allows us to determine the sequence of any DNA samples we provide. Sequencing, when paired with genomic databases, allows us to identify the compositions of bacterial communities in the gut down to the genus level. We can also use these tools to find out how the abundances of certain bacteria change over time and in response to other variables, such as high-fat diet and antibiotics. Research on the link between the human microbiome and the metabolic imbalances that lead to obesity could help us to pinpoint, one day, exactly how changes in the microbiome affect human metabolism and lead to obesity. This knowledge could help us learn how to restore unhealthy gut communities, allowing us to design a therapy against obesity in a not-so-distant future. [Photo courtesy of NYU Langone Medical Center]!
Prions: A Link to Alzheimer’s Shengie Ji | NYU College of Arts and Sciences 2016 As medicine has gotten more advanced, so have, unfortunately, the diseases it fights. Bacteria and viruses have been keeping up with medicine, but a new threat has also been emerging from a new front. You may have heard of it due to its most well known strain known as Alzheimer’s: prion disease. It is an emerging and lethal crisis for modern society. Even though it has been identified for half a century, prion disease has only had the medical world’s attention for less than half that time. A prion is very simple: it is a malformed protein. A malformed protein, however, when in the right location, runs the risk of denaturing other well-formed, functional proteins, rendering them useless. This particular branch of proteins gets in the body through a variety of ways. Whether it is ingested or injected, it incubates in the body for an undetermined period of time. After the incubation period has ended, prions move through the Blood Brain Barrier (BBB) entering the brain through the spinal cord. Once in the brain, the protein malforms, and the brain shuts down as a result, unable to complete even the simplest of tasks. The primary method of prion transmission is usually through ingestion. However, it’s not common enough to be found in everyday foods or bodily fluids. Kuru, one type of prion disease, is known to affect cannibal tribes since they are exposed to infected brain matter when they eat other humans. These proteins are then able to stay in the human body, usually residing in the small intestine. The gestation period of the prion is one that still requires a lot of research. Since cases are !
not immediately prevalent and the toxicology is hard to identify, it is hard to determine just who has this disease. As a result, the time frame for this period is especially hard to pin down. Kuru, for example, has a gestation period of 50+ years. The strand which most commonly affects humans has a gestation period of anywhere from 10-50 years. Since this period is the longest, yet simultaneously the most difficult one to study, as there are not outward symptoms, many researchers spend decades to collect data. After the disease gets into the body and gestates, the proteins are signaled and start to move towards the brain. The permeability of these proteins is very low. Many prions never travel across the epithelium of the small intestine into the bloodstream, which may be why prion disease is not more prevalent, but in the case when the protein makes it through the spinal column to the brain, the effects are lethal. There has been research into cures, but unfortunately they have all been so far experimental at best. The problem is the structure of the protein. Since the structures and amino acids present in the malformed and original proteins are exactly the same, autoimmune responses are often just as destructive as the disease itself. This makes specific cures for the protein just as ineffective, since the normal proteins would be destroyed as well, and the bottom line would remain the same. There is so little known about this unfortunate disease. However, there have been many research projects put into place, and advancement has been on the horizon. Medical research is always a risky and agonizing venture, which is why it is important that people understand modern research as it comes. As time goes on we will always be facing challenges within the world of microbiology and it is the sacred duty of our scientists and researchers to make sure we are up to the task.
Malar ia in Ghana: Gaining Insight on Knowledge, Attitude s, and Belie fs Toward Malaria Vector Control Chytanya Kompala, Bonnie MacLeod NYU Steinhardt 2014 Accra, Ghana May 2012
Introduction Malaria presents itself as a major public health concern due to the high rates of morbidity and mortality caused by the disease, especially in subSaharan Africa. Sub Saharan Africa accounts for 80% of the estimated 2 million deaths per year caused by malaria worldwide [i]. Currently, malaria is the leading cause of morbidity and mortality for pregnant women and children under five. These demographics are a major concern and add a heightened level of urgency to the situation. Not only is malaria negatively affecting the health of individuals, but it also puts a major strain on the heath system and creates an economic burden on the nation. In Ghana, 30%-40% of outpatient cases are due to malaria and 61% of hospital admissions of children below age five are due to malaria [ii]. The high rates of malaria put a major strain on Ghana economically. Increased rates of malaria are linked with poverty. Furthermore, when an individual is infected with malaria, the economic burden for the country is heightened due work and school absenteeism. Because of these alarmingly high rates, recently there has been a large push from the global health community to reduce the prevalence of the disease. Due to the global spotlight on reducing the prevalence of malaria in sub Saharan Africa, especially from the Millennium Development Goal )#! !
related morbidity and mortality. More than one-third of the 108 malaria endemic countries (9 countries within Africa and 29 outside of Africa) documented reductions in malaria cases of greater than 50% in 2008 compared to 2000 [iii]. Specifically in Ghana, there have been attempts to strengthen health care services and make prevention strategies more available. The Ghanaian Roll Back Malaria campaign has partnered with several organizations including WHO, UNICEF, NetMark, and bilateral agencies to promote insecticide treated nets (ITNs) campaigns [iv]. In spite of this progress, there are still endemic rates in many African countries including Ghana and further interventions need to be implemented. In order to combat this epidemic, efforts need to be made on the government, community, and individual levels. In West Africa, and specifically Ghana, individuals do not necessarily perceive malaria to be a major burden on their lives. This is a contributing factor to the lack of prevention among individuals. Given the nature of malaria transmission, and the difficulties eliminating mosquitoes on a large scale, it is the responsibility of individuals to protect themselves against the disease. In an effort to control the burden of malaria, several preventive methods have been developed and proven effective. Malaria vector control is used to protect individuals against becoming infected by !
mosquito bites. This has been shown on a community level to reduce the incidence of malaria transmission [v]. Malaria vector control is most often achieved through prevention methods including insecticide treated nets (ITN), residual spraying, personal repellents, and maintaining a clean environment. All of these means of control can be employed at the individual level, thus placing the responsibility of preventing transmission in the hands of individuals. The ability to effectively use individual methods of prevention lies heavily on the knowledge, attitudes and beliefs one holds on malaria within the community.
Background We conducted a study consisting of individual surveys taken by patients in a private family practice clinic in the Greater Accra region. This survey questioned patients about perceptions of malaria and knowledge about personal methods of protection and treatment. During this study, we were able to observe local attitudes towards the disease and individuals’ perceived risk of infection. In this study, we analyze the usage and believed effectiveness of several means of personal prevention against malaria.
Methods Site Description This study was conducted in the main lobby of Child and Associates. Child and Associates is a private pediatric clinic that also treats adults located in North Dzorowulu of the Greater Accra Region. The general Greater Accra Region is malaria endemic and malaria is a common reason for patients to come in to the clinic. On average, about twelve patients were received a day. Child and Associates is a part of Omni Clinic, which includes a laboratory and dental services. Methodology This study used social research methods to determine individuals’ perceived risk of becoming infected with malaria and their knowledge,
attitudes and beliefs towards the disease. The research was conducted between January and March 2012. Participants were selected based on the criteria of being patients of Child and Associates, living in the Greater Accra Region, and being parents. Individual surveys were conducted verbally by trained interns. Patients were approached in a professional way. This survey was completely voluntary and some patients chose not to participate in the study for personal reasons. Instrument The survey was designed to grasp a concept of the knowledge, attitudes, and beliefs surrounding malaria within this specific community. The categories of the survey include demographics (age, sex, education level, neighborhood of residence, and occupation), perceived risked, prevention methods and treatment. A total of 53 parents were selected from the waiting room of the clinic. When asked what the participant’s perceived risk was, we then followed by asking why this was the case. To understand what the participant’s basic knowledge about malaria was, we asked them where malaria comes from and what are the risk factors that can increase one’s chance of becoming infected with malaria. Next, we asked them what specific methods of personal prevention they used to understand what are the most popular methods of prevention. Then, the participants were asked to rate the effectiveness of using nets, repellents, having clean surroundings, wearing protective clothing and staying indoors as methods of protection from malaria. This demonstrated local beliefs about the effectiveness of specific means of protection. Then, to understand their knowledge about the pathology of the disease, we asked them what they believed to be safe hours of the day, and the signs and symptoms of malaria. We also asked whether parents would treat themselves the same way they would treat their children if infected with malaria to gage if their would be any discrepancies. Finally, we asked what they believed was the most effective treatment.
Results and Analysis From our raw data, we coded the responses depending on the question to better quantify the results. We began by comparing demographic variables by looking for correlations between different sets of data. Demographics The majority of our participants are female and hold a graduate degree. Out of 53 participants, on a scale from one to ten, one being the least and ten being the highest, the average perceived risk is 3.8. Males perceive their risk to be slightly higher by 0.5 compared to females as demonstrated in Figure 1. Older age groups have slightly higher perceived risks, with an increase of 0.2 for every seven years of age as demonstrated in Figure 2. Participants with higher levels of education perceive their risks to be lower by 0.3 per every degree earned as demonstrated in Figure 3. As age increases, the number of modes of protection used decreases. As the level of education increases, the number of modes of protection increases. In addition, as the perceived risk increases, the number of modes of protection increases as demonstrated in Figure 4.!
Figure 1: Gender vs. Perceived
Figure 2: Age vs. Perceived Risk!
Figure 3: Education vs. Perceived Risk!
Figure 4: Perceived Risk vs. Number of Modes of Protection Used!
Figure 5: Frequency of Use of Different Modes of Protection!
Figure 6: Average Ranking of Different Modes of Protection on a Scale of 1-5!
Figure 7: Frequency of Knowledge Ratings!
Prevention Methods Used We asked participants if they use clean surroundings, bed nets, repellents, sprays, clothing, drugs, or staying indoors to prevent malaria. 41.5% of participants use clean surroundings. 56.6% of participants use nets. 71.7% of participants use repellents. 20.8% of participants use spray. 17.0% of participants use protective clothing. 5.7% of participants use drugs. 9.4% of participants stay indoors to avoid mosquitoes as demonstrated in Figure 5. We asked participants to rate nets, repellents, clean surroundings, clothing and staying indoors on a scale from one to five, five being the most effective. Participants on average believe that clean surroundings are the most effective with a score of 4.3, followed by nets with a score of 4.2, repellents at 3.5, staying indoors at 2.9, and protective clothing at 2.9 as demonstrated by Figure 6. Knowledge and Understanding In order to quantify participant’s general knowledge and understanding of malaria, we created a ranking system from 1-3. Participants received three points if they knew the “safe hours” of the day (early morning to afternoon), and identified both fever and headache as symptoms of malaria. Participants received two points for identifying the “safe hours” or identifying both fever and headache as symptoms. Participants received one point if they were unable to correctly identify either of these. 31 out of 53 participants received 2 points, 14 received three points, and 8 received one point as demonstrated in Figure 7. In addition, 23 participants listed body aches and pains as a symptom. 14 participants included nausea/stomach problems, and 14 participants included fatigue/weakness. Treatment When asked what participants would do if they or their child showed signs of malaria, the most common response was to see the doctor. 15 participants said they would respond differently if their child showed symptoms compared to if they showed symptoms. When asked what was the most effective treatment, the most common response was medication. !
Discussion and Conclusion Our findings show that malaria control is an ever-pressing burden on this community. With an average perceived risk of 3.8, it can be said that malaria is an everyday mild concern. When examining the personal malaria vector control, education and understanding of effective modes of prevention is essential. The majority of the population of our study is highly educated; most of our participants hold college and/or graduate degrees. Such levels of education may be a contributing factor to the overall low average perceived risk of 3.8. These high levels of education may have contributed to the high levels of personal vector control, and should be encouraged to be used even further. Additionally, it is interesting to note that 12 out of 53 participants say they would self medicate if they believed they had malaria. This may potentially be concerning due to the high and spreading levels of drug resistance. Future Steps On an individual level, the most effective way to prevent becoming infected with malaria is to continually take anti-malarial drugs. However, these drugs are extremely expensive and are not advised to be taken for multiple years at a time. A more realistic option for locals in a malaria endemic community such as Accra is the use of multiple, daily modes of protection. Rather than simply relying on one means of protection to prevent malaria, the use of different and concurrent methods of protection should be used. For example, individuals should strive to always wear repellent, especially in the evening and early morning as well as spray their homes and sleep with insecticide-treated bed nets. In order for this behavior change to take place, individuals require adequate knowledge and understanding about malaria and how one is infected. Specifically, it is important for individuals to understand the safe hours of the day as well as risk factors that can increase their chances of infection.!
In order for this change to be possible within a community, local governments and agencies should support educating individuals and the use of individual vector control. In addition, governments should promote increasing the accessibility of bed nets, sprays, and repellents by ensuring their affordability and availability. This could be done by subsidizing the cost or increasing the production of these products so that they are more readily available. Specifically, pregnant women and children under five are more vulnerable to malaria related morbidity and mortality and therefore the government should push to target these groups further. To further our study, it would be interesting to conduct this survey within a rural population and compare the findings. It would be meaningful to compare the knowledge rankings about malaria in terms of rural and urban communities to see if education campaigns are comparable.
Alilio M., Bygbjerg I., Breman J. 2004. Are Multilateral Malaria Research and Control Programs the Most Successful? Lessons from the Past 100 Years in Africa. The American Society of Tropical Medicine and Hygiene: 268-278. Asante F., Asenso-Okyere K., Economic Burden of Malaria in Ghana. Institute of Statistical, Social and Economic Research, University of Ghana: 1-81. Baird J., et al. 2002. Seasonal Malaria Attack Rates in Infants and Yound Children in Northern Ghana. The American Society of Tropical Medicin and Hygiene: 280-286. Bejon P., 2009. Analysis of Immunity to Febrile Malaria in Children Than Distinguishes Immunity from Lack of Exposure. American Society for Microbiology: 1917-1923. Breman J., et al. 2004. Conquering the Intolerable Burden of Malaria: What’s New, What’s Needed: A Summary. The American Society of Tropical Medicine and Hygiene:1-15. Breman J., et al. 2007. Defining and Defeating the Intolerable Burden of Malaria III. Progress and Perspectives. The American Society of Tropical Medicine and Hygiene: vi-xi. Breman L., Holloway C., 2007. Malaria Surveillance Counts. The American Society of Tropical Medicine and Hygiene: 36-47. World Malaria Report 2009. World Health Organization. 1-78.
Chytanya Kompala and Bonnie MacLeod are undergraduate students of Public Health at New York University. They both recently spent a semester abroad in Accra, Ghana where they worked at Child and Associates, a local pediatric clinic. During their time there, Chytanya and Bonnie conducted research on malaria prevention through individual vector control.
Roll Back Malaria Monitorying and Evaluation: Ghana: 1-7. Idro R., et al. 2010. Severe Neurologicla Sequalae and Behaviour Problems After Cerebral Malaria in Ugandan Children. BMC Research Notes.1-6. Lutje V., 2010. Randomized Controlled Trials of Malaria Intervention Trials in Africa, 1948 to 2007: A Descriptive Analysis. BioMed Central Malaria Journal. Massum H., et al. 2010. Africa’s Largest Long Lasting Insecticide Treated Net Produce: Lessons from A to Z Textiles. BMC International Health and Human Rights. 1-6. Menon, S., 2010. Perspective: Filling in the Gaps of the Global Research Agenda for Eliminating Malaria. Journal of Public Health and Epidemiology. 87-92. O’Meara, W. et al. 2005. The Promise and Challenges of Malaria Treatment. Malaria Journal. 1-10. Okech, B. et al. 2008. Use of Integrated Malaria Managment Reduces Malaria in Kenya. PLoS ONE. 1-9. Pulford, J. et al. 2011. Reported Reasons for Not Using a Mosquito Net When One is Available: A Review of the Published Literature. Malaria Journal. 1-29. Guidelines for the Treatment of Malaria. 2010. Second Edition. World Health Organization.
[i] Okech Kenya [ii} MDG Ghana [iii] Full Malaria Report [iv] Roll Back Malaria Monitoring and Evaluation [v} Full malaria Report
John Hellman, M.A. Director of Advocacy Latino Commission on AIDS Now that the excitement of the XIX International AIDS Conference is over, we have been left with a number of new announcements, interventions, and sets of data to grapple with as we attempt to reach the end of AIDS. While there have been a number of very exciting advances in treatment and prevention that some argue could potentially turn the tide of the epidemic, there is also a general sense that something may be missing, or the ways that HIV/AIDS is being addressed is not enough. This essay will highlight the epidemiological trends mentioned at the International AIDS Conference while understanding the relationship between the most affected populations and the primary questions that we, as advocates, are asking in relation to reaching the “end of AIDS”. The only way we can understand and address the impact of the epidemic on the most affected groups is by understanding the political and social positions that these populations occupy on a local and global scale.
In addition to this, according to the Kaiser Family Foundation’s most recent data set on the HIV/AIDS epidemic in the United States, also released in July 2012, • •
The Data The XIX International AIDS Conference featured panelists, speakers, and delegates from many diverse countries, but two populations were consistently in focus as the two main focal points of the epidemic: men who have sex with men (MSM) and women of color. According to the Kaiser Family Foundation’s most recent data set on the global HIV/AIDS epidemic released in July 2012, • • !
Women represent about half of all people living with HIV worldwide. Most new infections are transmitted heterosexually, although risk factors vary.
Sub-Saharan Africa is home to two-thirds (69%) of people living with HIV, and women represent more than half (60%) of people living with HIV in this region. Young people, ages 15-24, account for 40% of new HIV infections and young women are twice as likely to become infected with HIV than their male counterparts.
Most new HIV infections are among gay, bisexual, and other MSM (61% in 2009). Young gay and bisexual men are the only group for whom new infections rose between 2006 and 2009, which was largely driven by a significant rise in new infections among young, Black gay and bisexual men (an increase of 48% between 2006 and 2009). Blacks and Latinos account for a disproportionate share of new HIV infections, with Black having the highest rates of new HIV infections and new AIDS diagnoses of any racial/ethnic group
With these groups of people as the focal point of the conference, many panelists and speakers urged governments, advocates, and other players to invest more resources, promote more effective interventions, and raise more awareness of how the epidemic continues to disproportionately affect +)!
these populations. For the most part, many of the solutions to these problems were solutions we’ve heard before: address stigma, link people to care, increase access to treatment, and increase funding for HIV/AIDS services. Since many people have already argued why these strategies are important for these populations, I will not do that here. Instead, I want to turn to what the emphasis on these arguments reveal about where we are on the road to “end AIDS”. Are we in a good position to even begin to end AIDS? Are the most affected populations in a good position to end AIDS? Are the strategies that we promote – particularly the emphasis on treatment and stigma – the most effective ways to get to this end of AIDS? Addressing Stigma and Advancing Treatment, right? In order to think about this date in terms of our “position”, I would like to bring up a quote from one of my favorite philosophers, Michel Foucault. In the collection of his lectures titled Society Must Be Defended, he urges us to think differently about the nature of the law and our relationship to systems of power. Foucault argues that, “The system of right and the judiciary field are permanent vehicles for relations of domination, and for polymorphous techniques of subjugation. Right must, I think, be viewed not in terms of a legitimacy to be established, but in terms of the procedures of subjugation it implements.” In this quote, Foucault (who died of neurological problems associated with AIDS) urges us to understand the relations we have with power, emphasizing that our relationships to power are
the primary way to measure our position in society. We must constantly be vigilant of how relationships between power and those that are marginalized change, even when “progress” is achieved. In order to illustrate this in relation to the most affected groups, I want to look at one significant shift in the history of the HIV/AIDS epidemic – the shift to understanding HIV as a “chronic disease” instead of an “infectious disease”. While the technical definitions of “chronic” and “infectious” overlap quite a bit, the justification for this shift involve two main components: treatment advances and stigma. The first argument is that treatment advances can, according to the science on the concept of “community viral load”, effectively reduce the chance of transmission significantly. Additionally, treatment regiments, if adhered to, have made HIV less of a so-called “death sentence” and much more manageable, evidenced by the ability of people living with HIV to live longer, healthier lives. The second argument is that the shift from “infections” to “chronic” reduces the stigmatization of the disease. People living with HIV continue to face discrimination based on false understandings of the nature of HIV, ranging from HIV being known as a “gay disease” or the recent report of a man being sprayed with Lysol from his coworkers out of fear that they would catch HIV somehow from being around him. So, if HIV is understood as a chronic disease, people would understand it as a more manageable, less scary disease. These two issues – treatment advances and stigma – are two of the most important issues that HIV/AIDS advocates raise, and this was
especially evident at the International AIDS Conference. Making various form of treatment more available to those in need all around the world while increasing education about the nature of HIV and safe sex were two of the main tools that were promoted across the board at the Conference. So, naturally, emphasizing the switch from “infectious” to “chronic” was a main component to this strategy. This shift is generally thought of as a positive one, and most people, including such bodies as the Centers for Disease Control and Prevention, have adopted it. I am not interested in whether these changes as either good or bad, or whether or not this definition of HIV is even true. Instead, I want to look at how this particular shift reframes the conversations around HIV and what it enables (or disables) when we think about “ending AIDS”. First, let’s look at the argument that shifting this definition from “infectious” to “chronic” reflects advances in treatment. Treatment advances are one of the most highlighted issues in the epidemic, and from PrEP to microbicides to an actual “cure”, the International AIDS Conference was no different in focusing a lot of attention on this issue. This conversation was often paired with the “treatment cascade”, a graph that demonstrates the huge gap between those diagnosed with HIV and those with suppressed viral loads, which has become one of the most popular tools to discuss the challenges we face in addressing the epidemic. According to the CDC, only 28% of those with an HIV diagnoses have a suppressed viral load, which serves to emphasize the need to connect people into care and the need to develop better
adherence to treatment. With these new advances in treatment, whether as prevention or as a functional cure, many advocates argue that the end of the epidemic is within reach. PrEP has been hailed as a gamechanger. The promise of a cure is on the horizon. In other words, advances in treatment and our ability to link as many people as possible to care are two of our main tools to address the epidemic. This sentiment is reflected in the vision statement of the National HIV/AIDS Strategy, released more than two years ago by President Barack Obama. The statement reads: The United States will become a place where new HIV infections are rare and when they do occur, every person, regardless of age, gender, race/ethnicity, sexual orientation, gender identity or socio-economic circumstance, will have unfettered access to high quality, lifeextending care, free from stigma and discrimination. Treatment is a very good thing, and making sure that there are many healthy options to address the epidemic is a smart strategy to capture the different needs of different populations. But in a world where, say, there is a cure for HIV and everyone has access to this cure, is it an individual’s fault if s/he is still infected? Since we cannot force anyone to be treated for HIV, does this primary emphasis in treatment and adherence potentially enable the argument to be made that “irresponsible” people living with HIV are to blame for the impact of the epidemic? If HIV is indeed a “chronic disease” and someone is still suffering from its effects, do we blame their failure to manage this “manageable” disease?
Second, let’s look at the argument that changing the definition from “infectious” to “chronic” has a positive impact on how HIV is stigmatized. At the International AIDS Conference, the problem of stigma received a lot of attention, and advocates and activists called for renewed commitment to end the stigma associated with HIV, whether that means challenging HIV criminalization laws that still exist or challenging homophobia and transphobia that also has an impact on HIV stigma. The “infectious” to “chronic” switch was included in this need to reduce stigma, but could this have had unintended consequences, especially for the populations that are the most impacted? This year, the Centers for Disease Control and Prevention released new data from research conducted in Baltimore, Los Angeles, Miami, New York City, and San Francisco that found that among men who have sex with men aged 23 to 29, particularly Black and Latino men, there has been an increase in HIV prevalence from 1994 to 2008. In New York City, most discussions point to the idea that young people just don’t understand the full weight of an HIV positive diagnosis since treatment advances have made it a more manageable condition. In response to this idea, the New York City Department of Health and Mental Hygiene sponsored a social marketing campaign aimed at this population titled “It’s Never Just HIV”. This campaign highlighted that an HIV diagnosis could put you at higher risk for dozens of other diseases even if you take medications, like osteoporosis, dementia, and anal cancer. This 30 second commercial featured all men, presumably men who have
sex with men, and received both praise and pushback from people who work in HIV/AIDS in New York City, both siding on opposite side of the commercial’s use of scare tactics. Those who praised it argued that since these young men are not concerned about HIV anymore, they need to be scared into making sure they always have safe sex. Those who opposed it argued that not only was the commercial homophobic, but it essentially re-stigmatizes HIV by portraying those living with HIV as carriers of multiple degenerative diseases. This tension between understanding the seriousness of HIV and destigmatizing HIV is an unavoidable and contentious issue that points to some major concerns about how we understand to road to “end AIDS”, especially when it comes to those populations that are most impacted. How do we simultaneously emphasize the impact that HIV could have on one’s health while promoting compassion and understanding to those infected by the virus? Given the overall position of the most affected populations, who are also devalued because of their geography, race, gender, poverty, or sexual orientation, is this even possible? This twin and sole emphasis on treatment and stigma seem to lead us down a path to, at best, nowhere, or at worst, a very dangerous position. If arguments on treatment only reinforce the idea that certain populations are irresponsible leeches of the system, or if arguments on stigma do not go far enough to address the full reality of those most affected, how can we possibly say with any certainty that we are anywhere near the end of AIDS?
Conclusion Remembering the Start to Get to the Finish My point in critically understanding the emphasis on treatment and stigma in this particular way is not to suggest that we should not be doing this work. What I am suggesting is that we reframe our conversations and ask different questions when we consider data that, again and again, point to the disproportionate impact of HIV/AIDS on people of color, particular young, female, and queer people of color. We know that the populations most affected by the epidemic are often the poorest, most disempowered of their respective societies that are demonized for being drains on the system. If we are to adequately address the needs of these populations, we must understand that arguments that we may consider to be essential to our strategy may dovetail with arguments that seek to undermine any so-called progress that we have fought hard to achieve. When we think about the birth of HIV/AIDS politics, we must remember that governments turned a blind eye to those that were dying, that most of society stigmatized those that were affected or ignored the problem altogether. Countless people have struggled – and continue to struggle – to advocate for access to treatment, to destigmatize HIV and AIDS, and to increase the quality of life of all those living with HIV or AIDS. The issues that these activists were raising cannot be adequately addressed by only giving people treatment and reducing the stigma. Emphasizing these may even be missing the point entirely. The conditions that helped develop the epidemic into what it is today – political
disempowerment, systemic poverty and discrimination, violence – are what continue to allow the epidemic to thrive in the most affected populations. While these issue are sometimes mentioned during a discussion on HIV/AIDS, solutions to these particular problems are either not mentioned or considering “beyond the scope” of HIV/AIDS work. I remember attending a session at the International AIDS Conference that emphasized the needs to address “structural factors” that contribute to the epidemic. One panelist in particular argued that something like the North American Free Trade Agreement, or NAFTA, could be a significant contributing factor to the spread of HIV in some Latino populations for a variety of reasons. What struck me as odd and indicative of the problem I try to raise here is that in the section on solutions, “repeal NAFTA” was nowhere to be found. While I am not suggesting that NAFTA should be repealed, I wonder if, as HIV/AIDS advocates and activists, we are even in the position to advocate for something like “repeal NAFTA” if that could actually help curb the epidemic. If we are serious about “ending AIDS”, we must seriously reflect on the political and social position that we find ourselves in relation to all of the problems that contribute to the epidemic, particular for those most affected.
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Scholarly Exploration in El Barrio Andre Marston | Education Collaborator NYU College of Arts and Science 2014! Education is undoubtedly one of the basic fundamentals from which a society grows and develops. Academics foster intellectual inquiry and can provide a plethora of opportunities. Though the merits of getting a diversified education are near interminable, the challenges that have long plagued the educational experience remain. Socioeconomic disadvantages create imbalances that skew the accessibility of resources in favor of certain demographics while marginalizing and excluding others. Fixing such inequities is no simple task because they are rooted in already complicated factors such as race, ethnicity, class, and citizenship. Nevertheless, these obstructions are not insurmountable. My time working for a middle school ESL teacher in East Harlem has strongly reaffirmed my belief in differentiated teaching and learning’s positive impact on underprivileged youth, especially those who are new to this country. I began working with Ms. Adrian Spatzer in September of 2010 after being placed in her class through America Reads. The idea of getting to work directly in the classroom as a college freshman was exciting enough. But little did I know all I would witness and in which I would participate. First of all, the class’s demographics were unlike any I had encountered before. The students were all English Language Learners (ELLs), and an overwhelming majority hailed from the Hispanophone Caribbean and Latin America. Some had been in the United States for a couple years; some arrived only a few days prior. As a result, there was a wide range in speaking ability in addition to the existing language barrier. Amazingly, the expert teacher knew from the beginning how to turn a tough situation into a learning experience for everyone. She was responsible for teaching English Language Arts and Science. For the former subject, she
split the class into two groups: the beginners and the moderate to advanced ELLs. Her student teacher and I worked together with the beginning-level students. Meanwhile, Ms. Spatzer worked with the more Englishproficient group. This set-up established a classroom dynamic from the start that is essential to a productive environment. The students responded well to the arrangement because their respective needs were the focal point. For the latter subject, she utilized a bilingual format to its fullest advantage. The students had the option of taking the class in their more academically dominant language. So approximately half of them took the class in English, and the rest received translated copies of the curriculum material. Spatzer then took advantage of my proficiency in Spanish by having me interpret as she spoke. We became a duo that could keep the whole class engaged simultaneously. Her enthusiasm did not stop there. She invested her own money into purchasing lab supplies so they could do experiments and had them write lab reports on a regular basis. The eighth grade math teacher, a native Spanish speaker, employed the same strategy with this set of students. He went so far as to translate class materials into Arabic for the newly arrived young man from Yemen. These collaborative and creative methods for teaching a group with different levels of English-speaking ability engendered active participation across the board. The results I saw were truly a testament to the great heights a class can reach with proper guidance and extra effort on everyone’s behalf. All the students passed the New York State Exams, many with flying colors. Furthermore, the 8th grade valedictorian and salutatorian were both ELLs. They delivered speeches at the graduation ceremony thanking their families and peers and giving a brief summary of their plans for high school. These are only a couple of the students’ various accomplishments.
After an incredible first year together, the teacher and I decided to take on a summer project in 2011: translating the entire science department’s documents and miscellaneous classroom materials into Spanish. We began the undertaking in June and finished in August. Seeing the fruits of our labor used in other ELL classes at the school the following academic year was beyond rewarding. The feeling was further enhanced by the curricular adjustments made by my teaching superior. To begin with, she put a renewed emphasis on nutrition since it normally did not receive the attention it deserved. Interactive assignments, films, experiments, and other assorted additions made the science curriculum for the year more dynamic and exciting to explore. This level of dedication to offering a top-notch school experience despite financial difficulties is actually a key component to maintaining public health. The connections between academics and the wellbeing of the general public are certainly numerous. Scholastic opportunity and achievement open doors and allow young people to feel supported in their social efficacy. I have noticed this especially applies to students living in low-income areas. The students with whom I work come from humble backgrounds, and it is reflected in their work ethic. They go the extra distance at the inexhaustible encouragement of their teacher. They write essays and other compositions to articulately express themselves; are always excited to start examining a new topic in class; and read novels with increasing fluency. Their families work extra hard to provide, so these young adults greatly appreciate the incomparable value of an education. It is this kind of gratitude that keeps students motivated. Motivation, in turn, leads to progressive improvements that make our society a better place rife with active participants who think of ways to facilitate community empowerment. Content definitely plays a significant role in the quality of education offered and the impact it leaves as well. As mentioned earlier, Ms. Spatzer wanted to delve extensively into nutrition. She proceeded to bring in fascinating articles, groundbreaking book The Omnivore’s Dilemma, and eye-opening documentary Food, Inc. By incorporating all these resources, the
class engaged in lively dialogue analyzing current issues in the food industry. They were critical of contemporary food processing procedures and postulated possible ways to rectify the situation. Moreover, they reflected on their own alimentary choices to see how they compared to national statistics. Conversations arose about disparities in food quality, prices, and options. In their neighborhoods they saw the overwhelming availability of unhealthy choices that quickly become addictive. These units exemplified the magnitude of education’s grand potential for younger generations, particularly those in urban centers like New York City. Students immediately began to reevaluate their eating habits and thought of ways to improve their diet. Such retrospective keenness presented the chance to effect real change in themselves as well as those around them. The nutrition section showcased the solid base upon which education rests, its ultimate purpose: selfempowerment. Teachers’ and other administrators’ influence only goes so far before the students’ own initiative must take the reins. It should be any outstanding teacher’s goal to promote independent critical thinking. Pooling together different resources that enhance learning in the face of economic adversity realizes such aims. Student empowerment contributes so much to society that the obstacles pale in comparison to the outcomes. All areas of study that are explored by enthusiastically inquiring minds consequently better public welfare in different ways. Getting an education means more than simply getting a diploma with concomitant bragging rights. It signifies gaining a lucid consciousness of the world surrounding you. With this awareness comes a unique power. Intellectual power is exactly the tool necessary to give socially disadvantaged youth a platform to have their voices heard. I am without a doubt excitedly anxious to see what the upcoming school year will bring with this amazing educator and her brilliant pupils.
Andre Marston is a junior majoring in Romance Languages. He has worked in East Harlem through America Reads with his cooperating teacher of two years, an ESL/bilingual educator at M.S. 45. +&!
The “Fisted-Hand Syndrome”: Looking at Domestic Violence From a Public Health Lens Renán E. Orellana | Co-Editor-in-Chief “In the nineteenth century, the central moral challenge was slavery. In the twentieth century, it was the battle against totalitarianism. We believe that in this century the paramount moral challenge will be the struggle for gender equality around the world.” ! Nicholas D. Kristof, Half the Sky: Turning Oppression into Opportunity for Women
Marianne, the national emblem of France. Columbia, the female personification of the United States of America. Britannia, the female visual representation of Great Britain. These national emblems represent the ideals of personal and social liberty, the foundations for democracy and freedom. Monuments erected in countries throughout the world, including Bulgaria, El Salvador and Latvia, use a female figure inspired by the image of the Roman goddess Libertas, the symbolic embodiment of personal and national liberation. The irony lies in how this emblematic symbolization of freedom and liberty uses the image of a woman, while throughout the world, women and girls continue to be bound to lives of sexual slavery, abuse, oppression and violence. Billions of women have yet to break free from binding chains of oppression. The idea that a woman is the “universal” icon used to commemorate personal and social liberation disturbs me. It’s incongruity with the realities faced by women around the world becomes a misrepresentation of a gender that continues to face subjugation, exploitation and injustice. A Portrait of Domestic Violence Around the World UNiTE, the United Nations SecretaryGeneral’s campaign to end violence against women, spotlighted domestic violence (also known as ‘intimate partner violence’) as “the most common form of violence against women worldwide, without regional exception” .
Global trends indicate that “women aged between fifteen and forty-four are more likely to be injured or die as a result of male violence than through cancer, traffic accidents, malaria and war combined” . A report by the Geneva Center for the Democratic Control of Armed Forces put it into the most gruesome but tangible terms: “violence against women causes every 2 to 4 years a mountain of corpses equal to the Jewish Holocaust” . The billions of cases of domestic violence across the globe manifest themselves differently, with varying degrees of intensity and severity in the oppression, maltreatment and subjugation faced by the victims of abuse. At the end of the day, however, domestic violence in any form is intolerable and should be put to an end. The Centers for Disease Control and Prevention documented that one in four women (25%) has experienced domestic violence in her lifetime . Sadly, open discussion of individual cases of intimate partner violence is rare, as it tends to happen in secret due to its confinement primarily to the household setting. Since the woman tends to live with her abusive partner, it is uncommon for others outside the household to be aware of the violent situation she endures. Facing financial and emotional dependence to her abuser, most often a member of her own family, a woman can be bound to a lifetime of abuse without ever finding an escape route from this world of oppression. By compounding stigmatization and the inculpation of victims of domestic violence in certain communities, many women begin to feel as if there is no way out of this hopeless situation.
There are certain places around the world where the penal system does not yet recognize domestic violence as a legitimate legal concern. Consider Russia, where an estimated “14,000 women were killed by their partners or relatives in 1999, yet the country still has no law specifically addressing domestic violence” . Furthermore, traditional practices that enable the perpetuation of domestic violence in certain countries have been commonplace for centuries. Thousands of Indian and Pakistani women are “victims of ‘dowry deaths’, killed because their bride-wealth is deemed insufficient by the groom’s family” . An estimated 5,000 women are killed every year in ‘honor’ crimes, according to the United Nations Population Fund, and certain countries do not prosecute or punish murders perceived as ‘honour killings’ . Consider a study of female deaths in Egypt, where “47 per cent of the women were killed by a relative after the woman had been raped” . It is also estimated that ‘honor killings’ take the lives of least three Pakistani women every day . Gender-based violence is the leading cause of injury to women around the world, given that at least one in every three women has been beaten, coerced into sex or otherwise abused during her lifetime . In the U.S. and Europe, the concept of domestic violence may not seem to be a pressing issue to address in the overburdened political and legal arenas. But the reality is that when statistics on domestic violence against women indicate that “three to four million women in the United States are beaten in their homes each year by their husbands, exhusbands, or male lovers,” the issue of gender violence should become a highpriority issue to address in public policy and public health . A study showed that “ninety-two percent of women surveyed listed reducing domestic violence and sexual assault as their top concern” . Despite the necessity and public demand for reform in !
addressing domestic violence, why is the issue not a priority or top concern on the political agenda to the extent that it should be? James Allen Fox, author of The Will to Kill: Making Sense of Senseless Murder, explains how “social and legal interventions to abuse victims [are] not equally extensive in all parts of the country” . This is a recurring issue in public health considering that providing accessibility to services – be it clean water, vaccinations, healthcare, or sanitation – across the general population is always a difficult task, especially when dealing with marginalized and isolated groups. In addition, the “feminization of poverty” contributes to a woman’s economic vulnerability and in turn shapes how vulnerable she is to violence. The Urban Predicament and “Stockholm Syndrome” Bind In a similar way to many other public health interventions, the availability of interventions for victims of domestic abuse varies according to the urbanness of the location. The general decline in the percentage of femicides involving an intimate is primarily in larger cities where there is a greater emphasis in providing resources for battered women . Not only are abuse hotlines, shelters, support groups and counseling services less available in the suburbs and in rural areas, but access to “escape routes” also becomes a problem in these less urban settings. Women may remain in dangerous or potentially lethal relationships “to avoid the stigma within her small community” . The psychological effects of abuse can also restrain a woman from leaving an abusive partner. Some women face a phenomenon similar to the “Stockholm Syndrome,” which was used to describe the compliant behavior of wartime hostages toward their captor. Some domestic abuse victims may become “trapped in a violent relationship [and] become more closely bonded to the attacker….[focusing] exclusively on his real or imagined good points” . Another phenomenon, labeled by Fox as “learned helplessness,” binds a +(!
mother to her abusive partner due to her frustration for “ineffectual struggles to repel early episodes of abuse…[which develops into] a sense of resignation that she is helpless in controlling her fate or that of the children” . An Economic Blow Domestic violence should be seen as a complex and multidimensional phenomenon that takes into account psychological, biological, socio-cultural and economic factors. The result of violent behaviors intertwines the individual, familial, community and societal dimensions and their consequences take place in diverse contexts and conditions . Domestic violence is shown to increase morbidity and mortality rates, and debilitates women, an integral part of the workforce. Billions of women are an untapped economic force that can contribute significantly to a country’s economic growth. Placing human rights issues to the side and considering reform solely for its economic gains and increased yields by the workforce, statistics indicate that “domestic violence victims lose nearly 8 million days of paid work per year in the US alone—the equivalent of 32,000 fulltime jobs” . Furthermore, consider it as a widespread issue in preventable healthcare spending when “women who have experienced domestic violence are 80 percent more likely to have a stroke, 70 percent more likely to have heart disease, 60 percent more likely to have asthma and 70 percent more likely to drink heavily than women who have not experienced intimate partner violence” . The Cyclical Nature of Domestic Violence The first step in understanding the perpetuation of a phenomenon should be to understand its roots and origins. Apart from
the pervasive systems of inequality around the world, the culture of “male chauvinism,” a traditional sexist outlook, is a prevalent mentality that perpetuates the subordination of women and drives this particular cycle of violence. Around the world, men feel a sense of patriarchal responsibility to have absolute control over family matters . Usually having the position of the “breadwinner” within the family unit, any perceived insubordination or threat to a male’s self-entitled absolute control over family matters is frequently met with force or violence. In these circumstances, the abusive husband’s “sense of ego and selfworth depends on his ability to control, dominate and manipulate his wife and children” . Children ultimately become secondary victims and are instrumental in the continuation of domestic abuse across generations. Male children raised in these violent households develop skewed conceptions of manliness and typically inherit their father’s perception of household power dynamics . And girls (unless taught otherwise), become victims of this cycle when they are taught by their parents that this is the way a marriage or intimate relationship should function. Studies show that “witnessing violence between one’s parents or caretakers is the strongest risk factor for transmitting violent behavior from one generation to the next” . Statistical evidence on the perpetuation of this cycle indicates that “boys who witness domestic violence are twice as likely to abuse their own partners and children when they become adults,” learning that battering and physical aggression are normal and acceptable ways of expressing their frustration and resolving conflicts . In order to eradicate domestic violence, this chauvinist culture must be changed, specifically by addressing the possibility of breaking the cycle through social interventions targeting children.
Curing the “Fisted-Hand Syndrome”: FTST prevention efforts
women [can] erode the patriarchal control men have historically had over their spouses”.
Contemporary methods of dealing with domestic violence merely point fingers, reprimand and criminalize the perpetrators, and offer support and restoration to the victims of a violent ordeal. There should be a reevaluation of public policy and social movements against domestic abuse and a focus on prevention efforts. We cannot simply defer the issue to the legal system any more. Instead of simply placing a band-aid on the issue, we should espouse comprehensive interventions and approaches that seek to end the deeply rooted cycles of abuse that will continue to perpetuate this unacceptable cultural and societal phenomenon. It becomes a public health problem when domestic violence places a burden on the health and well being of victims and other members of the community.
Several public health campaigns against the AIDS epidemic focus specifically on preventing mother-to-child transmission (MTCT) of HIV. Maybe the eradication of domestic violence should adopt a similar approach – preventing the father-to-son transmission of these twisted gender roles, ending a cycle that justifies the traditional and outdated perspective that a man’s patriarchal duty entitles him to use force to secure his absolute control over a woman.
The inaccessibility and unequal distribution of services and interventions are two of the most critical issues faced in the field of public health. This is a problem in dealing with domestic violence as social interventions that empower women or provide legal outlets and financial independence are inaccessible in certain communities and nations. Yes, restraining orders, mandatory police arrest procedures and divorce laws have become viable escape routes for some women in most developed countries, but more sustainable interventions should further the involvement of women – 51% of the world’s population – in legislative, financial and community affairs. Though the current state of gender dynamics in the U.S. still requires considerable advancements, the significant progress made during the past few decades should serve as a template in understanding how “improvement in the economic status of
1 “UNiTE: United Nations Secretary-General’s Campaign to End Violence Against Women.” United Nations Department of Public Information. (DPI/2546A). November 2009. (Masthead) 2 Vlachoud, Marie, and Lea Biason, eds. "Women in an Insecure World: Violence against Women, Facts, Figures and Analysis." Geneva Centre for the Democratic Control of Armed Forces (DCAF), 2005. 3 “Extent, Nature, and Consequences of Intimate Partner Violence.” The Centers for Disease Control and Prevention and The National Institute of Justice. Atlanta, Georgia. July 2000. 4 "Women and Violence." Hearings before the U.S. Senate Judiciary Committee. August 29 and December 11, 1990. Senate Hearing 101-939, pt. 1, p. 12. 5 "Fast Facts on Domestic Violence." Office of the Clark County Prosecuting Attorney. Domestic Violence: Fast Facts on Domestic Violence. Accessed September 18, 2012. www.clarkprosecutor.org 6 Fox, James Allen, Levin, Jack, and Quinet, Kenna. The Will to Kill: Making Sense of Senseless Murder. Indianapolis: Purdue University, 2007. 7 Buvinic, Mayra, Andrew Morrison, and Maria Beatriz Orlando. "Violencia, crimen y desarrollo social en america latina y el caribe." 2005. Accessed September 18, 2012. 8 Tjaden, Patricia, and Thoennes, Nancy. “Costs of Intimate Partner Violence Against Women in the United States.” The Centers for Disease Control and Prevention and The National Centers for Injury Prevention and Control. Atlanta, Georgia. 2003. 9 Break the Cycle. (2006). Startling Statistics. http://www.breakthecycle.org/html%20files/I_4a_startstatis.htm. 10 Strauss, Gelles, and Smith, “Physical Violence in American Families: Risk Factors and Adaptations to Violence in 8,145 Families.” Transaction Publishers, 1990.
New School Year Resolutions: Keep Stress Levels Down Richard Hsu | Fitness & Healthy Living Columnist NYU Steinhardt 2015! School’s started back up and we all know what that means: stress. However, in a beautiful concrete jungle as New York City, our rapid daily activities can only inadvertently raise the tension between our shoulders. Cortisol, the “stress hormone” released from the adrenal glands, is seen in the body’s fight of flight response in the sympathetic division of the nervous system. Often times this reaps positive effects such as a quick boost of energy and maybe even the capability of lifting a car up.
Council, studies, including two in a recent issue of the journal Accident Analysis and Prevention, show that the effects of sleep deprivation are similar to the changes in ability and judgment seen in a person under the influence of alcohol. "Seventeen hours without sleep is equivalent to a .05 blood alcohol level, and 24 hours without sleep is like a .01 blood alcohol level.” Good thing we live in the city where the majority of us do not drive.
However, stress can really take away the gains of your overall health. It can create various problems such as lowered immunity and higher blood pressure. The following tips can give you a few options to release that tension and allow you to at your optimal levels of activity.
Avoid Stressed People Honestly, in a school of 22,280 students (in 2011-2012’s year), you can certainly find less stressful people. We are programmed with “mirror neurons” that mimic the ones around us. Growing up, I was taught that every person was the product of his/her five closest friends. This only makes sense when you think about the activities you engage in every day. Just think, you begin the school year completely different from your roommate, and if you maintain a relationship with your roommate, you typically end up finishing each other’s sentences. Well, perhaps not that drastic, however one typically begins to develop similar traits due to environmental influences.
Sleep Clearly the most obvious, however many college students forget how crucial getting shuteye can be. According to the McKinley Health Center at the University of Illinois at Urbana-Champaign, a college-aged person should get 7 to 8 hours of sleep each night. Insufficient sleep can be dangerous and often lead to debilitating effects such as anxiety, cognitive difficulties, depression, and reduced physical health. Additionally, we are carbohydrate fiends. As your brain utilizes all the blood sugar supply, it begins to lack the energy stores it needs to function. Thus functionality begins to diminish. Put it simply, your brain needs sugars. Fun Fact: According to the Police Policy Studies "+! !
Exercise When you’re paying a relatively high amount of money for tuition, take advantage of your resources. Specifically, the gym. With Coles and Palladium nearby, it only makes sense to hit the gym and go for a run.
Bear in mind, for those who live near campus, Yoga to the People is a donation based foundation that is an option as well. “Feeling stressed evokes tense, shallow breathing, while calm is associated with relaxed breathing,” says Michael Lee, author of Turn Stress into Bliss and founder of Phoenix Rising Yoga Therapy in Bristol, Vermont. Vitamins/Magnesium Taking your vitamins is a critical part of maintaining a well-balanced body. Include fruits into your diet or pop one of the multi-vitamin pills. Drinking an abundance of alcohol can actually strip you of your body’s nutrients, thus Sunday mornings are a good time to vitamin load up. Magnesium serves as a key role in various functions in the body, especially combating stress. If your body lacks in magnesium, it is vital to restore balance back into your body. This will allow for your body to have positive biological responses to stress. Magnesium will aid in muscle relaxation and in conjunction to sleep, magnesium will calm excited cells and promote restful sleep.!
TEAM Renán Orellana, Co-Editor-in-Chief Renán Orellana is a junior in Steinhardt studying Public Health and Poverty Studies. His experiences in developing countries have given him a global perspective on the interplay between poverty and health. He is interested in such issues as international development, complex humanitarian emergencies, the pathology of infectious diseases and preventive medicine. Renán hopes to go to medical school and further his public health studies by getting a degree in epidemiology or global health. His pastimes include swimming and biking and his music tastes include reggae, ska and bossa nova. Jorge Zárate, Co-Editor-in-Chief Jorge Zárate is a junior at NYU’s campus in Abu Dhabi studying Biology and Political Science. Jorge is originally from Mexico, but grew up in Argentina and China. Jorge is currently part of a microbiology lab, focusing on the link between the microbiome and host metabolism. He is also interested in health disparities and public health in a global context, he hopes to go to medical school after graduation and get a degree in public health or get involved in epidemiological research. Jorge likes cooking, going to the movies and taking photographs in his spare time. Tara Azizi, Managing Editor Tara Azizi is a senior in the NYU College of Nursing. She currently works part time as a Care Partner for Renewal Care Partners, specializing in dementia. She has previously worked as a research assistant in a musculoskeletal disease center where her work was published and orally presented at the 33rd American Society of Bone and Mineral Research Annual Meeting. Tara also serves on the 1831 Fund Student Leadership Committee and is secretary of the NYU Baha’i Club. Additionally, she is Greenwich Hotel’s Director of Training and Development. After graduation, Tara plans to further her education and pursue a Master’s degree in Health Policy and Management. Katie Nolan, Operations Coordinator Katie Nolan is a junior at NYU Steinhardt studying Public Health and Public Policy. Her experiences working with international non-profits sparked her interests in medical systems and health policy, both domestic and abroad. Her past times include doing yoga, playing the flute and running.
Any questions? Contact the Editors: Renán Orellana (email@example.com) or Jorge Zárate (firstname.lastname@example.org) email@example.com Logo by Alejandra Pinto Miguel, NYUAD ‘14
The Torch | www.nyutorch.com
Published on Mar 5, 2013
[Revised] New York University Journal for Domestic and Global Health, Vol. 1, Issue 1