PUBLIC HEALTH ADVOCATETHE

an official publication of the Cal Undergraduate Public Health Coalition

Issue 10, Fall 2009

Building Health

To our beloved readers:

While our leaders in Washington tackle the ever-com-plex issue of healthcare reform, we at the Public Health Advocate decided to take a look around at all the day-to-day infl uences that impact our health and well-being. We are both products and producers of our environment. Whether we recognize it or not, we continually shape it through our conscious decision-making as well as our daily habits. � is issue explores the ways in which we as individuals, communities, and as a society are building or destroying health.

How we garden, what we eat, the way we design our cities, and how we provide services to citizens all impact our local and global community. We cannot rely solely on our representatives in DC to create health. Instead, we need to take a proactive approach and, as the public, work together to build healthier environments beginning at individual and neighborhood levels.

We hope this issue challenges you to think of creative ways to address barriers to health in your life!

Best,

Alisa Bern & Cait Lang

2

Letter from the EditorsCo-Editors-In-Chief Alisa Bern Cait Lang

Business Manager Sandee Young

Layout Editors Sandy Bhaurla Peter Hess Hansel Ihn Michelle Lee Greg Reynolds Marvin So

Copy Editors Mihir Bikhchandani Celia Bonaduce Tiff any Huang

Contributing Writers Monisha Ashok Christina Lee Sylvia Leung Michelle Louie Annie Odom Alicia Olivarez Alec Reynolds

Photographer Peter Hess

Faculty Advisor Tony Soyka

Special � anks To School of Public Health PH Alumni Association Kaplan Ann Marie Pettigrew Tristan Nichols CalUPHC Exec Board Fricke-Parks Press

The PHA Staff

The Public Health Advocate is not an official publication of the University of California, Berkeley, the ASUC, or the School of Public Health. The content in this publication does not necessarily reflect the views of the University the ASUC, or the SPH. Letters to the editor and article proposals are encouraged and should be sent to either: publichealthadvocate@gmail.com Public Health Advocate, 10 Eshelman Hall, Berkeley, CA 94720©2009 The Public Health Advocate

3

Co-Editors-In-Chief Alisa Bern Cait Lang

Business Manager Sandee Young

Layout Editors Sandy Bhaurla Peter Hess Hansel Ihn Michelle Lee Greg Reynolds Marvin So

Copy Editors Mihir Bikhchandani Celia Bonaduce Tiff any Huang

Contributing Writers Monisha Ashok Christina Lee Sylvia Leung Michelle Louie Annie Odom Alicia Olivarez Alec Reynolds

Photographer Peter Hess

Faculty Advisor Tony Soyka

Special � anks To School of Public Health PH Alumni Association Kaplan Ann Marie Pettigrew Tristan Nichols CalUPHC Exec Board Fricke-Parks Press

4 How did we get here? By Christina Lee6 Hurting and Healing By Sylvia Leung8 Ghana By Michelle Louie 10 � e Importance of Charity By Cait Lang12 Cholera and You By Greg Reynolds14 More than Just Curb Cuts By Annie Odom16 Take a Look Around By Peter Hess18 A Space to Grow By Alicia Olivarez20 Solving Your Own Omnivore’s Dilemma By Alec Reynolds22 Cholesterol By Greg Reynolds24 Alumna Adventure By Monisha Ashok26 What About Meat By Marvin So28 � e Medical Marijuana Debate By Celia Bonaduce30 Medicine in the Media By Sandee Young

Table of Contents

HERE ?Understanding Healthcare Reform

� e current state of the United States health care industry has been shaped by a series of policies that have been enacted predominantly in the last fi fty years. With nearly 47 million uninsured and the unsustainable rise in healthcare costs, the demand and interest in healthcare reform has been rekindled and now stands as a blazing controversy following the 2008 presidential election. A fundamental understanding of past policies and the history of both successful and failed health reforms will provide insight to the present state and the future of our health care system.

Christina Lee Contributing Writer

4

Internal Revenue ActMakes employer based insurance exempt from income taxes.

Eff ects:• Forgone federal tax revenues ($246 billion in 2007) • Most people now receive health insurance through their employers.• Employees gain more comprehensive health benefi ts.

Health Maintenance Organizations(HMO) ActMandates that HMO plans be off ered in every state and allocates federal funds to support the establish-ment of new HMOs.

Eff ects:• Increases the number of HMOs • Most insured today are under a managed care plan, like HMOs.• Leads to short term health care cost savings.

Medicare and Medicaid enactedMedicare provides universal health insurance to 45 million disabled and elderly (> 65 years).Medicaid insures 59 million low-income Americans (primarily families).

Eff ects:• Expands insurance coverage to some vulnerable populations.• Rising health care costs raises concern over the sustainability of these government run programs.

Clinton’s Health Security Act FailsAttempts to acheive universal coverage through employer mandate, by expanding government oversight and restructuring the insurance enrollment processes.

Why does it fail?• Does not involve Congress in the development of the bill and thus fails to gain Republican support.• Strong opposition from doctors, drug companies, and insurance companies.• Occurs during a time of growing public discontent with managed care, which fostered a fear of change that might further limit choice or access.

1954

1965

1973

1993

How did we getP

ub

lic

Hea

lth

Ad

voca

te

5

Christina is a fourth year majoring in Pub-lic Health, with a minor in Public Policy.

She loves to swim, travel, and watch movies during her free time and plans to purse

a dual degree in medicine and masters in public health after college.

State Children’s Health Insurance Plan (S-CHIP)Federally funded insurance that expands coverage to 7.4 million children.

Medicare Modernization Act(Medicare Part D)Adds prescription drug coverage to Medicare, which greatly increases Medicare expenditures.

Massachusetts Healthcare ReformMassachusetts achieves nearly universal coverage for its residents by mandating that all individuals have health insurance. � e govern-ment provides subsidies to increase aff ordability and those who do not purchase insurance face fi nancial penalties. As of 2009, only an es-timated 2.6% of state residents are without insurance, but aff ordabil-ity of health care remains a barrier to access. With the rising costs of care, there is also growing concern over the fi nanåcial sustainability of the program.

Current Reform Eff ortsPresident Barack Obama’s plan:• Creates a public health insurance option• Prevents insurance companies from denying coverage for pre-existing conditions• Creates a National Health Exchange for individuals and small businesses to pur chase insurance at more competitive prices.

Democratic Senator Max Baucus’ plan:• Creates an individual mandate. Failure to purchase results in fi nes• Imposes a 35 percent tax on insurance plans exceeding $8,000 • Allows insurance to be purchased across state lines• Encourages the development of health co-ops, a non-profi t health plan that is owned by its consumers and has limited government involvement.

Healthy San FranciscoExpands access to aff ordable and basic health care services to uninsured residents of San Francisco. Participation fees are adjusted for income.

Health Care Security OrdinanceRequires medium and large-sized employers in San Francisco to spend a minimum amount per hour on healthcare for their employees.

California’s “Year of Health Reform” FailsCalifornia introduces several proposals that fail to pass through both the Legislature and Governor. Major reform components of these proposals include:• Individual mandates• Expanding eligibility for public programs• Subsidizing coverage for low-income Californians• Off ering tax incentives for the purchase of insurance• Developing a single-payer system that replaces the private market.

1997

2003

2006

2007

2009

prehensive student health centers in the nation.” In uphold-ing its commitment in providing accessible health care to students, the UHS maintains the same hours of service and the same Student Health Insurance Plan (SHIP) benefi ts in-cluding new coverage for vision, pharmacy, physical therapy and ambulatory care. Moreover, the UHS has increased on-campus visits for Counseling and Social Services from a limit of 6 to 10 visits (the fi rst 5 of which are free). Nonethe-less, fewer students may choose to visit the Tang Center due to fee increases and potential for longer wait times from staff reductions. In response to the new copayments, 4th year Po-litical Economy major Marc Bacani states, “If I can’t aff ord it, or if I’m not willing to pay for it, then my mindset is to deal with it myself.” For Marc and others like-minded stu-dents, copayments and other fees may infl uence a student to not seek or delay care; this is particularly troublesome for those with potentially serious medical conditions

� e economic recession and rising cost of health care aff ect more than public universities such as UC Berke-ley. Th is fall 2009 quarter, Stanford University established a mandatory Campus Health Service Fee of $167 per quarter to “allow the university to maintain valuable health services for students in the face of the unprecedented current eco-nomic downturn.” Compared to U.C. Berkeley students, Stanford students do not pay a copayment but do pay about $400 more per year for a health fee that funds on-campus health services. Tommy Tobin, a Stanford undergraduate and writer for the Stanford Daily, states that the “new fee has generated quite a negative reaction on campus, especially in the grad student population, which is angry: for not having a say in the fee, being forced to pay it even if not enrolled in the university’s health care plan, and due to a general lack of information about the fee, particularly during the earlier parts of the year.”

With the aforementioned changes to off set the im-pact of budget cuts and the economic recession, there is still an unanswered and, perhaps, unanswerable question of whether these changes will persist if the national and state economy turns around. In addressing this question, the UHS Director Claudia Covello responds, “Nothing is per-manent…but we will see how health care reform pans out…there are a lot of variables.” Even though the present tim es are diffi cult and the future remains uncertain, Claudia as-

Hurting and HealingUniversity Health Services Makes Diffi cult Decisions to Cope with Budget Cuts

T hroughout its century long history, the Univer-sity Health Services, commonly known as the Tang Center, has not required students to pay for a primary care or urgent care visit until this Fall

semester. On September 21, 2009, the University Health Services (UHS) introduced two new copayments: $15 for each primary care visit and $30 for each urgent care visit. UC Berkeley was one of the last UCs to introduce a co-payment for on-campus health services. While these new copayments are observable, concrete costs to students, the scope of these fees extend beyond the out-of-pocket costs to the student population and also represents a larger fi nan-cial issue that involves the entire state and other universities across the nation.

Obvious to many, California is undergoing a fi scal crisis that largely impacts the whole UC system including UC Berkeley. Less evident, however, is how the state fi scal crisis and the UC budget crisis have aff ected UHS, requir-ing it to reduce its budget by 23% which equals to $2 mil-lion in cuts. To make matters worse, nationwide health care costs are increasing at a faster rate than infl ation. With bud-get cuts and increasing health care costs, the UHS faces a dilemma in funding its health services to the U.C. Berkeley campus. UHS primarily receives funding from three sourc-es: (1) registration fees, (2) student health care fee and (3) fees charged for each service (e.g. Fee-For-Service). Because UHS’s usual funding from UC registration fees has been cut, UHS needed to increase the latter two sources of rev-enue to maintain quality student health services. To increase its third source of revenue (fees charged for each service), the UHS introduced copayments and modest fees increases for some ancillary, specialty and procedural services (e.g. $10 fee increase for psychiatry and dermatology services). Fur-thermore, UHS has reduced staff (over 20 positions) and increased business and operational effi ciencies through tech-nologies (including the implementation of online appoint-ment scheduling and electronic medical records).

While there is an array of implemented approaches to absorb the multi-million dollar budget cuts, how do such fi nancial decisions aff ect the quality and access of health care for students? Despite the budget cuts, the UHS has asserted its priorities as “providing high quality care and aff ordable, convenient services while remaining one of the most com-

Sylvia Leung Contributing Writer

6

Pu

bli

c H

ealt

h A

dvo

cate

serts that “[UHS] still has 100% com-mitment to high quality and accessible care to students.”

For more information on the budget cuts for on-campus health services and fees charged to students for using those services, please visit: http://uhs.berke-ley.edu/home/news/budget.shtml

University Insurance Premiums Copayment Health Fee On-Campus Services

UCBerkeley

Undergraduates: $1396 per year ($698 per semester); Graduate students: $1,932($966 per semester)

Increased to $0-15 depending on service and SHIP coverage

Increased to $102 per year ($3 more than last year)

Reduced Staffi ng

Harvard University

$1714 per year ($310 more than last year)

Increased to$10 for in-network providers, $50 for hospital stay or surgery; $12+ for prescription drugs

Decreased to $1126 per year ($300 less than last year)

Decreased: Prescrip-tion drug benefi ts and lab services no longer covered)

San Jose State University

No change: Depends on chosen plan

No change: $0-$25 ($0 for primary care and podiatry, $10 for most specialty care, $25 travel clinic)

No change: $150 per year ($75.50 per semester)

No major change

StanfordUniversity

$2400 per year ($800 per quarter)

No Change: $0 (cov-ered by health fee)

Increased to $501 per year (new instituted fee)

No major change

7

Sylvia Leung is a fourth year public health major and public policy

minor. She is particularly interested in the relationship between health,

culture and language. Her personal interests include learning languages,

practicing judo and experimental cooking. If you would like to ask her questions or provide comment about her article, you can reach her at snle-

ung@berkeley.edu.

Table: University Comparison of Copayments, Fees, Insurance Premiums and Services for Student Health Services

Photo by A

lisa Bern

Urgent care is one of the services for which students must now pay a copayment as of this fall semester.

This summer I traveled 8,000 miles to Ghana, a develop-ing country in West Africa. I spent fi ve weeks living in the

rural town of Ofaankor, volunteering at the Jei Krodua Health Clinic and help-ing out at the Royal Seed Orphanage next door. Although not all my experi-ences were positive, each made a last-ing impression on many of my personal views including my attitude towards the need for proper public health. As a public health major, I ven-tured to Ghana having a basic respect for the importance of public health. But, you know the saying “you never miss a good thing until it’s gone?” Well, it has come and gone, and now it is missed. While I realized how important public health is, I also was enlightened to how poverty and lack of infrastructure are major barriers to adequate public health.

� e orphanage was home to around 100 girls and boys who had made their way there under many dif-ferent circumstances and ranged in age from month-old babies to adolescents. It was a well founded orphanage that had been running for years and respect-ed in the community. But there were a number of common ailments seen in the children: malaria, typhoid, and

8

This summer I traveled 8,000

Michelle Louie Contributing Writer

Stephen was one of the many dedicated attendants working in rural Ghana.

ringworm. All of the children had large sores on their heads from the contagious and itchy ringworm fungus. � e other volunteers and I made an eff ort to get rid of it by washing the kid’s heads at night with medicated soap, but we found our eff orts in vain. � e children sleep virtually on top of one another on the unclean fl oor or bunk beds in tiny rooms, so in order to get rid of this disease we would have had to wash every kid’s head every night until the last spot of ringworm was gone, not to mention all the areas the kids sleep and anything else that their heads touch. If we missed even one kid or one mat, the fungus would continue to thrive in the orphanage. Here was a classic example of how treating the disease alone doesn’t work and how preventative measures are required. Collective structural changes need to be made in the orphanage in order to make a diff erence. � e perma-nent Ghanan workers at the orphanage need to be educated on what ringworm is and how it is transmitted. � en steps to create sanitary sleeping conditions and mandatory orga-nized head washing need to be taken. But the reality is such actions cost time and money that the workers at the orphan-age just do not have.

In the health clinic it was easy to see how poverty af-fected the patients. Most families we saw had limited in-come and their situation had to be profound in order to even come to the clinic. At the clinic about 90 percent of the sick patients I encountered were diagnosed with malaria or typhoid. Malaria is transmitted by mosquitoes and typhoid from bacteria in dirty water. Both are preventable and cur-able if given the appropriate medicine in time. � e doctor normally prescribed the same basic treatments to everyone without a confi rmed diagnosis, treating them for a range of diseases. Most people received the exact same cocktail injection and drugs and everyone who was given an injec-tion was given penicillin, which can lead to drug resistance! � e doctor was usually left with no choice, since the cost of performing a lab to possibly confi rm his diagnosis was too expensive for most people. I saw patient after patient opt out of doing a lab because they couldn’t aff ord it. To put it in perspective the cost to see the doctor is 1 cedi, which is equal to $.67 U.S. and 5 cedi ($3.50 US) to do the lab test, (which would test for malaria, typhoid, sickle cell, hemo-globin levels and urine and stool samples). � is clinic was one of the best in the area, people traveled many miles to

come to this specifi c clinic, the hallway was always full of sick people waiting to see the doctor, receive treatment or get their lab results back. � is clinic was a good health facil-ity compared to the neighboring ones, but their standards of care would not pass in the United States. One of the volun-teers once commented on the one needle per patient policy and the nurse looked at her straight in the eye and replied, “� is is Ghana”. � e nurse in three words had summed up the whole essence of healthcare delivery at this clinic; it is to do what they can with what little resources they have for the most amount of people.

I watched patient after patient walk into the clinic with the same diseases. Access to clean water would prevent half of these people from becoming sick, missing a day of work and having to pay for transportation, care and medicines. All of these costs take away from an already limited budget with little if any extra income.

Developing malaria or typhoid isis nearly unheard of in the United States. When we reach for our tap water the thought that it may be infected with typhoid does not cross our minds. When we walk around at night the thought of being bitten by a mosquito and developing malaria is not a concern. When we go to the doctor we expect a certain level of regulated care. � is is because of the organizations and structures in place to protect us. If any outbreak oc-curs we expect action, we demand public health. We look to our government, our leaders and our health professionals to come up with a solution to major health problems. But in this rural area of Ghana there is no such organization to look to or infrastructure in place to create and implement the so-lution. I met and worked with amazingly dedicated people that were doing all they could to help, but the poverty and informal atmosphere in this area only allowed them to be a bandages covering a much larger problem.

9

Michelle Louie is a fourth year Pub-lic Health major, with a minor in

Global Poverty.

Charity The fate of Charity Hospital hangs in the balance

Cait Lang Co-Editor-in-Chief

10

the Importance of

It’s funny how places we’ve never been can have such profound eff ects on our lives—a far off mountain range, a rural village, the cosmos. For me, the city of New Orleans forever changed the trajectory of

my career and my life. When Hurricane Katrina hit the Gulf Coast, I was glued to my television. I, like many, was outraged at our government’s failed attempts to provide adequate disaster relief services to those residents of New Orleans left behind after the storm. How could this happen in the United States? � e system had to change, and I wanted to be part of the movement to cre-ate new forms of policy and planning that would protect all people—not just the wealthy. � is understanding brought me to public health. I’ve wanted to volunteer in New Orleans since 2005; this summer I fi nally realized that goal through � e Magnolia Project, a student, staff , and faculty initiative committed to advocate a more comprehensive approach to rebuilding the Gulf Coast. Although the type of work has changed over the last three summers that Cal has sent students to volunteer, four years after Katrina New Orleans is still in need of repair. One of the most talked about issues while I was in New Orleans was the troubling public health crisis. His-torically, Charity Hospital, located in the heart of down-town, has served the city’s most vulnerable citizens—specifi cally the uninsured. Founded over 260 years ago, the public hospital has served as a teaching hospital and the cornerstone of New Orleans’ health services for generations. However, shortly after the events of Katrina, city and state offi cials announced that Charity would not be reopened, even though it had been deemed medical-ready after military and medical personnel had eff ectively decontaminated the hospital once fl oodwaters receded in September 2005. For four years now, its doors have been closed and the citizens of New Orleans are worse for it. � e Louisiana State University (LSU) medical system, which owns the building, has stated that it has no plans for reconstruction; rather, it plans to open a new LSU Medical Center and Veterans Association Hospital (VA)

on the other side of the interstate in Lower Mid-City. Th e new LSU center requires the demolition of 27 blocks of homes and small businesses and would cost an estimated $833 million. Proponents of this new center argue that it will create new jobs and opportunities for housing infi ll. Community organizers and residents alike argue that the city’s medical needs cannot wait for an entirely new hospital to be built. In addition, LSU’s proposed medical center would not serve those who desperately need care, namely the uninsured and the underinsured. An alterna-tive plan calls for the renovation of Charity Hospital and a small expansion to a neighboring site. Its central loca-tion to university health services and easy access to major highways are ideal for the city’s main academic medical facility. Similarly, the building itself is ideal: it was con-structed to standards far exceeding those of the time, and thus meets the majority of post Katrina fl ood require-ments. � is plan reestablishes Charity as both an aca-demic and a community resource, while simultaneously saving the city $283 million, avoiding the displacement of entire neighborhoods, and being completed in perhaps half the time of the LSU center. Supporters believe this is the moment to reimagine Charity as a new effi cient, sustainable model for future medical facilities. Unfortunately, policies that will best serve the New Orleans’ community are hampered by vested inter-ests and political corruption. In a recent fi ling, FEMA maintains that Louisiana state offi cials misrepresented and exaggerated the storm damage incurred at Char-ity Hospital in an attempt to present the building as beyond the fi fty percent threshold, which would require the federal government reimburse the state for the entire value of the building, approximately $492 million. � is sum would help fund the LSU project for which the state is currently hundreds of millions short. However, FEMA alleges that the three consulting fi rms that estimated the damage were not independent; in fact, they have ongoing fi nancial relationships with the state and thus incentives to produce biased cost estimates. In particular, Blitch/

Pu

bli

c H

ealt

h A

dvo

cate

11

Cait Lang is a third year Public Health major, with minors in Demography and Sustainable Design. She plans to earn a

masters in both Public Health and City and Regional Planning. She loves ballet and

wakeboarding!

Knevel and Associates, an architecture fi rm specializing in healthcare facilities, is under contract with the state to design the proposed new medical center slated for Lower Mid-City. Currently, FEMA has off ered $150 million to settle the Charity Hospital matter. � e battle between government offi cials and com-munity members as to whether Charity Hospital’s doors will open once again continues. On November 17, by a 7-3 vote, the Commission on Streamlining Govern-ment passed a motion ordering an independent study weighing all possible alternatives to, and the effi cacy of, the proposed LSU medical center. � is marks a victory for those supporting Charity Hospital; yet, by no means does this ensure a change in government policy. And the longer this matter remains within the courts the longer the people of New Orleans remain without adequate ac-cess to public healthcare.

For more information about Magnolia Project visit www.publicservice.berkeley.eduApplications due December 11, 2009

Many residents of the Lower 9th Ward have been unable to return home to New Orleans. Like Charity Hospital, lots remain empty waiting for someone to rebuild.

Photo by C

ait Lang

Photo by C

ait Lang

cleanliness. � ese people actually paid to go and be boated around a sewer system inside a cart that was used to dredge fi lth from the bottoms of the tunnels in the non-tour hours. As the citizens of the world traversed the sewers and spread word to their friends back home, a whole wave of sanitary reform came into place. � e straight, large streets became architectural and city design standbys despite their origins in suppressing popular revolt. � e aspects of Paris became, to a degree, synonymous with cleanliness and modernity. Essentially the world turned to the wonder of Paris with its

Paris in the 1800s smelled terrible; we are talking sewage mixed with some indescribable brand of terrible… one can only imagine the unique kind of stench. Terribly overworked and overloaded sewer

systems accompanied by factors like new population growth and an unusually hot year swept Paris into what is known as the Great Stink of 1880. Disease outbreaks seemed immi-nent to a populace who still held onto the tenets of miasma theory which proposed that diseases were borne on bad smells. Parisian offi cials turned to Georges-Eugène Hauss-mann to cure their city of the public danger of unpleasant smell. � e reforms and institutions of Haussmann have been passed into our world through intellectual descendants like the straight, broad thoroughfares of Shattuck and MLK. Today’s cities still feel the infl uence of yesteryear’s fear of killer smells.

As the Parisian public panicked, the ideas of Hauss-mann were put into overdrive, despite his ousting from of-fi ce nine years earlier. Haussmann’s goals were to increase and ease the fl ow of trade through the city, to clean and modernize the sanitation system and to make it easier for French offi cials to put down the riots that were in vogue at the time (see 1789, 1830, 1848). To these ends he proposed large streets with the dual purpose of drying out ground-water and preventing the blockades that cemented urban rebellion. Although large roads would be adequate to dry-ing up groundwater and easing traffi c, Hausmann proposed straight roads that created convenient lanes for cannons that, with a few shots, could intimidate any attempts at up-heaval. � e second prong of reform consisted of renovating the sanitary system with expanded sewers and better drain-age. Even in its fi rst conception Haussmannization was not all about public health but had a very mixed agenda. With popular outcry about smell behind his plan, Haussmann’s ideas were carried out to an excessive degree on the grounds of protecting the public’s health by protecting their noses.

Once Haussmann and his intellectual descendants were done with Paris it had a sewer system that drew tourists from around the globe. Lucky people from all nations toured the Parisian sewers and were delighted by the modernity and

Greg Reynolds Contributing Writer

12

Cholera and You:American Cities and the Legacy of French Disease Fears

A time period representation of the French fear of cholera in which the disease is a manifestation of death itself. Photo from Wikipedia.

Pu

bli

c H

ealt

h A

dvo

cate

wide, clean streets and beautiful sewers as an example to model their own cit-ies after.

� is legacy can be seen through the Rissanamento in Naples Italy. Like other major urban centers, Naples had serious issues with cholera outbreaks and the Rissanamento marked an at-tempt to fi x this problem. Although this movement ended up being inef-fectively carried out, (mostly due to interference by the period’s very active mob) the Rissanamento emphasized large streets that would allow sun into the thoroughfares and dry up the con-taminating groundwater that they be-lieved caused cholera. Trying to follow the success of Haussmannization, the Naples government declared the city “cholera proof”. Unfortunately, the disease broke out again but was violent-ly suppressed by the government and historians have only recently rediscov-ered this outbreak. Naples is just one in a long line of cities infl uenced and pushed towards sanitary reform by its people and the example of Paris.

� ese seemingly dry historical facts are handed down to you in the form of the city you live in. � roughout the modern world there are qualities in-spired by the Parisian model, a model that created its vision of public health around killer smells and suppressing rebellion. Berkeley and San Francisco both have many large major boulevards, which are not only wide enough to al-low sunlight in, but also serve to direct and ease the fl ow of traffi c and could theoretically be helpful in suppressing a rebellion. By creating the model city of its time Haussmann and his vision for Paris helped create the modern per-ception of a large city that includes a large subterranean sewer system, large major streets and an adequate system of public sanitation as too keep the smell of the sewers out of the streets. � e vi-sion of a healthy city was formed by

theories on disease prevention that are over one hundred years old. Although we no longer believe the smell of feces will give us cholera, we certainly do not enjoy the smell. In fact, many people still fear smells based on a general as-sumption that they mean disease is near and threatening. Pedestrians may know a smell will not infect them with disease but they still shy away from the odor and prefer more cleanly streets and value the aesthetics of clean cities. Germ theory may inform us on disease now but miasma theory still lives on in the crinkled noses of modernity and in the streets on which we make our way to school.

Cholera FactsCholera is a bacterial • disease passed via the fecal-oral route.Malnutrition, immuno-• compromise, and low stomach acid lead to increased cholera sus-ceptibility. Cholera is of concern in • countries with insuffi-cient access to anti-bac-terial drugs or proper diet.Zooplankton blooms of-• ten carry cholera lead-ing to coastal outbreaks of the disease.

13

Sacramento Street in Berkeley provides an excellent example of a street wide enough for transit, commerce and the occasional round of riot-suppressing cannon fi re. Photo by Greg Reynolds

American Cities and the Legacy of French Disease Fears

Greg is a third year double major in MCB and history with an emphasis towards the history of medicine and

science.

* Sanitary revolution information from Crispin Barker’s class History 138: American Sci-

ence, Engineering and Medicine and David S. Barnes’ book The Great Stink of Paris and the Nineteenth-Century Struggle against Filth

and Germs

� e newest, hottest realm of city planning is uni-versal design. Universal design spans city planning to fur-niture to appliances, advocating a design that all people can use throughout life, from adolescence to arthritis. Building design from its inception should accommodate everyone and all abilities; it should be non-stigmatizing and simple. Consider all the times that you have opted for a ramp in-stead of stairs, used the automatic door button to open a door when your hands are full, or rolled over a curb cut on your bicycle. � is design philosophy includes lever handles instead of knobs, wide, unobstructed hallways, handrails on both sides of ramps, tall side barriers over elevated surfaces. It even calls for wide grips on utensils and tools; there exists a corkscrew that follows this design. A relatively new phi-

More Than Just Curb Cuts

The role of city planning is an expansive one, in-corporating the natural layout of a city with the needs of the people. City planning is respon-sible for the designations of a city, from restau-

rants and shops to streets and transportation. � e disabled population is especially in need of careful planning as they may require more accommodations towards access than the non-disabled. Barriers like steps, curbs, uneven sidewalks, multilevel buildings, heavy doors, and many other build-ing components often impede access to disabled persons. Disability infl uences many lives, whether it be temporary or permanent; disability includes mobility impairments like wheelchairs, crutches, canes, diffi culty walking, climbing stairs, walking long distances; vision and hearing impair-ments; mental and cognitive impairments and many more. With the aging population, ongoing wars, and current med-ical technology, disability is on the rise and subsequently the need for barrier- free access. But while the Americans with Disabilities Act (ADA) sets the legal standard for barrier-free access, it is the philosophy of universal design that tran-scends the ADA to prioritize inclusive, equal access in the design for any object.

With the passage of the Americans with Disabilities Act in 1988, the barriers of past years are slowly eliminated as public buildings become more disability friendly. New buildings are being erected with access inherent in the de-sign while the buildings pre-ADA must retroactively imple-ment the regulations. City planning, especially in cities like Berkeley, promotes accessibility with the development of new buildings. Walking down the streets of Berkeley, you will encounter the majority of stores with fl at entryways, doors that are easy to open, and crosswalks with sound cues for the hearing impaired. � e city of Berkeley is disability friendly in many aspects, but the campus itself still poses problems for disabled students trying to get around. � ough the ADA has revolutionized the fi eld of disability access by drawing attention to the issue and mandating codes, there is still much to be done in the realm of accessible design. Universal design builds on the standards established by the ADA to promote access in every possible aspect.

losophy, the principles behind universal design are simple, even though its implementation is not. Universal design spawns from the belief in a barrier free environment with seven major principles as follows: promotes equity, fl ex-ibility, and intuition in its use, conveys perceptible infor-mation, allows for error, requires low physical eff ort, and

Annie Odom Contributing Writer

14

Stair cases, among other things, are obstacles for disabled students around campus.

Photo by A

lisa Bern

Pu

bli

c H

ealt

h A

dvo

cate

allots the appropriate size and space. Universal design also considers the aesthetics of architecture, incorporat-ing access while still making a building noteworthy in its appearance. While these principles may seem obvious, why haven’t architects and city planners and even local citizens been advocating its use until now?

� e philosophy of universal design is an idealis-tic one and one that requires many compromises on the part of architects and planners. It requires creativity and understanding of disability and an ability to fuse this knowledge with application. It is costly to implement retroactively, like many accessible structures, and is new enough that many don’t know of its existence. And with the current recession and housing market, people ne-glect to look into the future in regards to building plan-ning, instead focusing on what is cheapest now. While the principles of universal design have seeped into some parts of city planning, like streets and bathrooms, there

15

Annie Odom is a fourth year public health, pre- med student who relishes watching movies and leisurely reading. She is most interested in infectious

diseases and disability studies. You can contact her at aodom17@gmail.com.

are few examples of entire structures that follow the prin-ciples of universal design and even less of those are in the U.S. But with the rise of disability, it is a necessity for this design to be incorporated into homes, offi ces, shops, res-taurants, schools, and health centers. As medicine keeps us alive longer, city planning is obligated to respond to this change in population. If people physically cannot access the services they require for daily living, then that is a detriment to their health and a great injustice. From a public health perspective, universal design allows us to move in safer, more accessible, simple environments, re-ducing the discrimination in access, the stigma and cre-ation of disability, and a general improvement to health as the stress associated with barriers is removed. So next time you walk through a building, check out the hallways, stairs, elevators, doorways, desks, bathrooms, counters, signage, even fl ooring and imagine all that could be done to make it more accessible.

Universal design is an adaptation of ADA standards that doesn’t sacrifi ce aesthetics.

The above map outlines paths throughout campus. The different colors signify the diffi culty level of the route (green being the easiest and red being the most diffi cult). For a better look at the map go to http://acads.chance.berkeley.edu/CAG/2005-GIS-Route-Slopes-Map-color.pdf

Source: http://acads.chance.berkeley.edu/C

AG

16

Photos by Peter Hess17

“

”

The Alameda County Health Department released a report in 2008 highlighting West Oakland as an area in which alcohol was more accessible than healthy foods.

Two successful community gardens that are a product of lo-cal organizations seeking “food justice” and “environmental justice” are the City Slicker Farms in West Oakland and the Quesada Gardens in Bayview Hunters Point.

� e Alameda County Health department released a re-port in 2008 highlighting West Oakland as an area in which alcohol was more accessible than healthy foods. � e report concludes that of the 22 stores that were surveyed, 100%

sold unhealthful snacks, 96% sold alcoholic bev-erages, and 80% sold fruits or vegetables. Of the fruits and vegetables that were available, most were not fresh and cost more than they would in large grocery stores. � ese alarming trends in fresh food availabil-ity coupled with the

fact that there are no large grocery stores in West Oakland certainly creates a need for green spaces such as those started by City Slicker Farms. City Slicker Farms was founded by local residents in 2000 and has fi ve urban farm locations and a number of programs including Food Distribution, Back-yard Garden Building, Composting, and Nursery and Seed Saving. � e farms were developed on either purchased or loaned plots of land, local schools, and in community mem-ber backyards throughout West Oakland. In addition to gar-dening, their mission includes increasing access to those that have the highest need for healthy foods and creating spaces that empower adults and children who “want to learn about the connections between ecology, farming and the urban en-vironment, and give West Oakland residents tools for self-reliance”. For example, the Center Street Farm used to be an empty lot with overgrown grass and liter; however, with the help of volunteers at City Slicker Farms and local residents the area has been transformed into a unique green space that houses “chickens, bee hives, a medicinal herb garden, a bar-becue grill, a composting operation, a bio-intensive market garden yielding over 2,000 pounds of produce per year, and a wildlife habitat perennial border”.

Within the fi elds of public health and city planning, there is an increasing eff ort on be-half of researchers and offi cials to collaborate in order to address the ways in which the

built environment aff ects the health of a community. � e presence of vegetation and green community spaces such as parks, urban farms, and communal gardens can greatly af-fect the physical and psychological health of a community. Studies have shown these green spaces can reduce mortality and morbid-ity by promoting physical activity and improving ac-cess to healthy foods. � e presence of these “green spaces” can also change the frequency and type of social interaction in a community by empower-ing community members to take control of community spaces that otherwise might be used for drugs, gangs, or violence. Community gardens such as those seen in our own backyards of Oakland and San Francisco have become valuable assets for urban com-munities struggling with high rates of crime and poverty.

Alicia Olivarez Contributing Writer

18

A Space to Grow

Is this really green space? In the hustle and bustle of most modern cities, a more “green” environment where the community can come together and enjoy a respite from urbanity yields both mental and tangible physical benefi ts.

Photographer: A

lisa Bern

Pu

bli

c H

ealt

h A

dvo

cate

How two local organizations fi ll the need

19

Alicia Olivarez is a fourth year Public Health major. After graduation in the

spring, she hopes to attend Public Health graduate school to study the health needs of communities of color. Currently, she is researching youth violence in Oakland. If you would like to talk about this ar-

ticle please contact her at aliciaolivarez@berkeley.edu

Th ey have also developed a weekly Farm Stand and a Saturday Market day where community members can socialize, get their kids involved in hands-on gardening activi-ties, and of course purchase freshly-grown produce at sliding scale prices. For an area that is known for its high poverty and crime rates, City Slicker Farms has become a green oasis in which community members can access locally grown produce and use the space to strengthen community ties.

Bayview Hunters Point is located in the southeastern part of San Francisco and has similar problems with poverty and crime as West Oakland. � e 100 percent resident-led Quesada Gardens Initiative intended to turn a community eyesore into a lush median thriving with vegetables, plants, and Canary Island date palms. Community residents have referred to their resoluteness to take over a plot of land and turn it into a community treasure as “guerilla gardening”. Not only are residents of the block encircling the gardens building friendships, numerous outside volunteers have also dedicated their time and energy to this community build-ing eff ort. � is type of community collabo-ration is impressive in an area known for its high homicide and violent crime rates. � e initiative also keeps residents of the Bayview Hunters Point connected through various community events such as fi lm festivals and movie showings and an art display in an empty storefront that will display fam-ily portraits of Bayview Hunters residents. Also, a joint eff ort between UCSF and the Quesada Gardens Initiative has led to the BayBloom project that will enable commu-nity members to get instruction and sup-plies to grow food in their own back yards 4. Although the organization began when residents were not sure if the barren plot of

land could even sustain green life, the result has led to vibrant community wide empow-erment that has deterred crime, increased ac-cess to healthy home grown foods, and cre-ated local events for community members to network and have fun.

Both of these eff orts transform gar-bage-laden spaces into thriving community hotspots that benefi t not only the health of the community but also increase social capi-tal. � e concepts of guerilla gardening, ur-ban farms, and backyard or community gar-dening are part of a growing trend on behalf of communities to utilize green spaces to highlight and strengthen community capaci-ties and assets. Given these social and health benefi ts, more attention should be paid to the possibility of using green spaces within low-income urban areas where un-policed parks and empty lots can actually breed violence and illegal activity. Green projects should be used to draw attention and support to other social justice issues such as poverty, food jus-tice, and crime that might also plague the area. Most importantly, green spaces and the individuals and community members who cultivate them give hope and inspiration to low-income communities struggling to put healthy foods on the table and have safe places for their children to play.

A Space to GrowOf 22 stores in Of 22 stores in Of 22 stores in Of 22 stores in West Oakland:West Oakland:West Oakland:West Oakland:

96% sell alcohol

80% sell fruits, vegetables

100% sell unhealthy snacks

Solving Your Own “Omnivore’s Dilemma”

20

Garden Volunteering in Berkeley

Ah, the land. Let us all throw back our heads and laugh our heartiest peasant laughs, perhaps sing-ing something from Fiddler on the Roof to set the mood. If current literature trends are any indica-

tion, America is scraping the rust off its green thumb and making fast tracks back to the agrarian idealism of its fore-fathers. Indeed, if you’re a freshman here in Berkeley the university has already tossed a copy of Michael Pollan’s � e Omnivore’s Dilemma at you. � e thesis is short and sweet: Americans have lost connection with their food and suff ered the consequences. Environmental degradation, obesity, famine, economic inequality; critics of the current agricul-tural system have blamed everything short of the apoca-lypse on our alienation from food production. And while it might all seem like distorted rhetoric from a political fringe, the statistics are certainly disconcerting. Obesity fi gures in the United States have more than tripled for men and more than doubled for women since the ‘80s. � e industrial farm-ing methods that make food so “cheap” in the developed world have taken their toll in the fi eld, where 70,000 agri-cultural workers die yearly from pesticide poisoning. With the bleak outlook presented by these numbers, it’s no won-der that health-conscious Americans are rethinking their re-lationship with food. However, now that you’ve come down with the “Pollan plague,” where do you go to exercise your new found commitment to sustainable agriculture? Before you don your overalls and start humming “Green Acres,” take a tour with me as I explore one volunteer garden in the Berke-ley area where you can get your hands dirty in the exciting world of urban food production. Despite this being a drought year, the sky over the Berkeley Youth Alternatives Garden (BYA) is leaking a steady drizzle, making the pile of compost in my wheelbar-row heavier by the second. Keeping the weight of the load centered over the wheel, I use momentum to propel myself over a hillock and push up on the handles of wheelbarrow. Rich black compost spills forth across the freshly-turned planting bed, exuding a pleasant musk that is magnifi ed by the rain’s magic. Savoring a spicy radish fresh from a neigh-boring bed, I revel at the agrarian arcadia realized before me. � e woman next to me, however, is less enthralled. Having just explained her distaste for invertebrates, she acci-

dentally decapitates a worm with her trowel. As she further emphasizes her dislike for our spineless compatriots through a series of low gurgling noises, I can’t help but wonder if you can decapitate a worm. Mulling over my woefully inade-quate knowledge of worm anatomy, I return to the compost pile for another load. Working in a volunteer garden can be fun and re-warding; it can also be dirty, hard and exhausting. More often than not these emotions meld to produce a sense of accomplishment that is hard to reproduce elsewhere. For a college student that is accustomed to churning out pa-pers, pulling up weeds (and resuscitating worms) can be a refreshing escape from a highly abstract intellectual lifestyle. However, the simplicity of gardening can be intimidating to a newcomer. Did I dig this bed right? Did I just pull a weed or a lettuce seedling? Do worms have souls? Fortunately, garden coordinator Kim Allen manifests the patience and understanding that makes the BYA a great place for begin-ners. If you can’t keep a houseplant alive or are concerned that gardening is too strenuous, the leeway that Allen gives to volunteers in choosing their tasks will ensure that you don’t end up impaling some poor sap with a rake out of frustration.

Photo by A

lec Reynolds

(Above, and opposite page) The Berkeley Alternatives Garden is a lo-cal community garden where volunteers can participate in weeding and digging beds. Volunteering at gardens like this one is an an easy way to both contribute to the community and reconnect with something most take for granted: food.

Pu

bli

c H

ealt

h A

dvo

cate

Solving Your Own “Omnivore’s Dilemma” As an arm of the Berkeley Youth Alternatives program, the BYA garden provides paid internships for youth (14+ years). While you won’t meet any of the interns at volunteer drop-in hours (Friday 10-1) for their West Berkeley location (on Bancroft between Acton and Bonar Streets), your help maintain-ing the garden is essential in providing a healthy learning environment for the youth. In the wise words of Mr. T, “It’s good for the bones, good for the chil-dren.” Volunteering at organizations like the BYA isn’t just good for the com-munity, it’s a great way to build personal skills and to further your connection with the most basic of necessities. My ex-periences at the BYA and other Bay Area gardens inspired me to pursue a sum-mer internship at an organic orchard. While most people may not aspire to this princely level of dirty hippy-dom, volunteering in a garden can teach you how easy it is to grow your own food. Even in the confi nes of my apartment, with its crowded environs and vague re-semblance to a Soviet tenement, I can still grow lettuce, radishes, and beets in planters. Self-suffi ciency may not be an option in an urban environment, but striking a closer relationship with our food can help us make more informed decisions on issues of public health, the environment, and agricultural policy. While Pollan and his contemporaries may have illustrated fundamental weak-nesses in American food production, fi nding the solution to these issues is a far more personal process. Putting worm apprehensions aside, local volunteer gar-dens are great places to start solving your personal “omnivore’s dilemma.”

Alec Reynolds Contributing Writer

21

Garden Volunteering in Berkeley

Berkeley Youth Alternatives GardenFor more information visit the BYA website (www.byaonline.org).

Alec Reynolds is a fourth-year study-ing history. He is best known among

readers for his impeccable bibliography formatting. If you want to talk to Alec about footnoting (Chicago-style only), contact him at reynolds_alec@berkeley.

edu.

Other Locations:

While the BYA garden is a great place for people that don’t want to make a large time commitment, there are plenty of other Bay Area organiza-tions that can give you hands-on experience in agriculture.

UC Berkeley Student Organic GardenI’ve never volunteered here, but their plot on the corner of Virginia and Walnut looks beautiful and is open on Sundays.

Contact: berkeleysoga@gmail.com

� e People’s Grocery

� e People’s Grocery is dedicated to pro-viding healthy, sustainable produce to West Oakland. Volunteering at their plot in Sunol inspired me to pursue a sum-mer internship on an organic orchard.Sunol Volunteering: marcelo@peo-plesgrocery.orgGeneral Volunteering: volunteers@peoplesgrocery.org

Cal Victory GardenLocated on the UC Berkeley cam-pus between Evans and Memorial Glade.Contact: calvictorygarden@gmail.com

Berkeley Ecology CenterCheck the Ecology Center’s EcoCal-endar for links to unique programs and volunteer opportunities around the Bay Area. � eir events are a great way to get out and meet people in the community while promoting a healthier environment.

Contact: http://www.ecologycen-ter.org/calendar

Photographer: A

lec Reynolds

tain the fl uidity of individual cell membranes under condi-tions of both heat and cold. � e kinks in the cholesterol molecule help cells stay in the relatively constant condition that we all have come to rely on.

� is points to the fact that there are a number of very good reasons for cholesterol to be present in a person’s daily diet. However, the current recommended amount of dietary cholesterol is only around three hundred mil-ligrams for a person with average cholesterol levels (Amer-ican Heart Association). � is amounts to about an egg and a half per day that a body can use or at least process. Even then some people naturally produce enough choles-terol on their own and do not need any extra from meats and diary. Essentially one must recognize who they are; a vegetarian with low cholesterol counts should probably be eating more eggs, and red meat enthusiast may want to cut back a little bit. � e key to this evaluation is to have your blood cholesterol levels tested by a doctor and then ad-just lifestyle from there. Although we need cholesterol it’s probably not a good idea to eat of lot of lamb brain (1900 mg of cholesterol per 100g of lamb brain, I kid you not). Exceeding the body’s ability to process cholesterol leads to increased depositing of plaque on artery walls which aids the progress of several diseases. Given the proper intake, cholesterol is our friend, but when LDL level is too high there is a serious problem.

Heart disease is linked to high cholesterol levels and is a major health problem for both men and women. Despite the common stereotype that men have heart disease and cholesterol issues (what TV show has not had a male char-acter have a heart attack at some point) but heart disease is actually more common amongst women. According to the Women’s Heart Foundation “since 1984, more women than men have died each year from heart disease and the gap between men and women’s survival continues to wid-en.” Part of the problem here is that plaque tends to spread more evenly in women (LDL is a signifi cant component of

At the very heart of things cholesterol is a mol-ecule; it contains a small polar head group and a bunch of carbon atoms. However, despite years of research, no one seems to particularly care

about the chemical intricacies of cholesterol except your occasional rogue chemistry major, and even he gets a little sleepy when someone starts talking about hydrophobic in-teractions. What most people fi nd important is whether or not this much-maligned collection of atoms will kill them fi fty years down the line. � e merits of cholesterol have been debated back and forth excessively, and by now it seems like a tired old argument; yet, most people don’t understand the most basic purpose of cholesterol in our bodies. Little do they know how much they rely on cho-lesterol for sex hormones like estrogen, progesterone, and testosterone, or that cholesterol helps keep their cells from forming a weird butter-like mass. Cholesterol is impor-tant to essential functions of the human body, however it’s over consumption can lead to serious health problems.

According to the American Heart Association there are two types of cholesterol: HDL and LDL Cholesterol, or “good and bad cholesterol” respectively. As choles-terol must be transported throughout the body (it is not soluble in blood) these “good and bad” cholesterols are diff erentiated on the amount of transport molecule that accompanies them. HDL is much higher in the transport molecule and thus is considered a good type of cholesterol linked to heart attack prevention in healthy amounts and its absence has been linked to heart disease.

Cholesterol in our bodies diff erentiates into several hormones that are essential to both male and female re-productive health. Estrogen and progesterone (the two major female sex hormones also found in smaller amounts in men) as well as testosterone (the most well known sex hormone) are all derived from cholesterol. Without these essential hormones the human body cannot function properly. Not only that, but cholesterol serves to main-

Greg Reynolds Contributing Writer

22

tain the fl uidity of individual cell membranes under condi-tions of both heat and cold. � e kinks in the cholesterol molecule help cells stay in the relatively constant condition that we all have come to rely on.

� is points to the fact that there are a number of very good reasons for cholesterol to be present in a person’s daily diet. However, the current recommended amount of dietary cholesterol is only around three hundred mil-

t the very heart of things cholesterol is a mol-ecule; it contains a small polar head group and a

Greg Reynolds Contributing Writer

Cholesterol: Friendly or Malignant Molecule?

Pu

bli

c H

ealt

h A

dvo

cate

this build-up) and this leads to a misdi-agnosis of normal angiographic studies (Women’s Heart Foundation). On the good side women’s hearts tend to react better to healthy lifestyle changes but with the problems in diagnosis it is dif-fi cult to make a change in time. � e key once again is regular checks on cho-lesterol levels (which help to show these problems coming) so that problems can be recognized while still reversible. If LDL levels are high, problems are easier to fi nd earlier, as LDL helps to make plague. � ese tests can also tell if there is enough HDL cholesterol to help clear this problem or discover that there is too little. A low HDL count may contribute to the problem as the American Heart Association states “low levels of HDL… also increase the risk of heart disease. Medical experts think that HDL tends to carry cholesterol away from the arteries.”

In the end cholesterol is neither a hero nor a villain-it all depends on the situation. LDL cholesterol is never go-ing to be that great for a person’s health but at the proper low levels it will prob-ably not cause major problems like ath-erosclerosis. HDL cholesterol is more diffi cult as its proper level is incredibly important, in some amounts it could lead to heart disease and in others it will help prevent plaque buildup. So visit your doctor, get your cholesterol levels checked, and the next time you see an egg do not shun it, but appreci-ate its benevolent yet moderate role in your body.

23

Despite their relatively high cholesterol content eggs do not need to be eliminated from human con-sumption by any means but rather moderated based on one’s preexisting cholesterol level.

Greg is a double major in MCB and history who secretly enjoys organic chemistry, eggs and vegetarianism.

Article at a Glance

There are two types of cholesterol: LDL or bad choles-• terol and HDL or good cholesterolProper maintenance of the levels of both types of cho-• lesterol is very important to one’s healthCholesterol serves several important functions for a • person’s cellular, sexual and general health but can be manufactured in the body at near sufficient levelsGiven the average level of cholesterol production and • the body’s threshold for cholesterol evacuation, the recommended amount of dietary cholesterol is 300 mg a dayHeart disease has been linked to high LDL levels and • is often mistreated in women whose symptoms are different and more difficult to identify

Photo by A

lisa Bern

project looks at healthcare in rural India and fi rst maps out all the providers and uses sur-veys to measure absence in public providers and to assess quality in private providers as proxies to access and availability. I was dis-turbed to fi nd out that more than 40% of public healthcare providers who are paid to work in rural clinics never show up and that many providers have no formal medi-cal training and yet no one stops them from setting up shop as a doctor. I am defi nitely learning a lot about the healthcare system in India and how the public sector approaches health care reform, great policies on paper but terrible at implementation. Our re-search project is an all India study that is be-ing conducted in all the major states in over 1,500 villages with over 75,000 healthcare providers. It is my job to coordinate with the companies that we have hired to do the primary data collection and data entry, to do the secondary analysis of the data to come up with interesting results for papers and policy recommendations, and to make sure that the project runs smoothly. I have to admit that at times it is intimidating be-cause the study is so large and being con-ducted in every state, but it does give me a chance to travel all over India. So far I have gotten to travel to Cochin, Chennai, and Bangalore, all cities in South India for piloting and training for our surveys.

Living in Delhi has defi nitely been an interesting expe-rience thus far. Despite the language barrier, I am learning to survive in this chaotic but incredibly lively city. Tasting dif-ferent street food, drinking chai (tea) every hour, and avoid-ing being ripped off by auto rickshaw drivers is always an adventure. It is actually not that diff erent from a life I would have had in the US since I live in a beautiful apartment in a

AlumnaLife and travels in India

As all other seniors, I hated the inevitable question that came up in every conversation – “So what are your plans after you graduate?” I was a Pub-lic Health and Economics major at Berkeley and

became interested in international development issues after taking Ananya Roy’s amazing Global Poverty class. It was diffi cult enough to decide what I wanted to study so decid-ing what I wanted to do after graduating seemed like an especially diffi cult question. I was still contemplating grad school, applying to healthcare consulting and private sector jobs (the practical option where I could potentially make some money, but I was not particularly interested in help-ing large hospitals or insurance companies), and applying to fellowships and nonprofi t jobs (the option I was more interested in, but scared my parents). I was truly keeping my options open. But after spending a summer in Peru doing a rural health project and spending another summer working on a water and sanitation project in urban slums in India, I knew that my passion lay in international public health and I was itching to get out of the country. Since I knew I wanted to go back to grad school to study health and de-velopment related issues, I decided I wanted to do research and started looking for research opportunities abroad. My economics advisor sent out information about the Jameel Poverty Action Lab (JPAL) that recruits students to work on development research project on health, education, micro-fi nance, etc. in various countries. I applied and as soon as I found out that I got accepted to do a rural healthcare project in India, I could not picture myself doing anything else.

� us, I moved to Delhi, India in July and have been living here for the past 3 months. � ere are four of us liv-ing and working together as research assistants for professors from Harvard, Duke, and UCSD and for people in the re-search department in the World Bank. � e project is funded by the Bill and Melinda Gates Foundation and coordinated through Innovations for Poverty Action, a nonprofi t that works with professors doing development research abroad, and the Center for Policy Research in India. Th e research

24

Adventures

Monisha Ashok Contributing Writer

Pu

bli

c H

ealt

h A

dvo

cate

nice part of the city with lots of restau-rants, bars, and malls nearby. Delhi is much more developed than I expected it to be with maintained roads, a brand new metro, and nice parks near the important monuments and parliament buildings. It is even attempting to be green with CNG public transportation and has banned plastic bags. In con-trast to Delhi, the rural areas that are a

part of my research project barely have roads and the main modes of transpor-tation are bullock carts, bicycles, and occasionally scooters. I feel privileged to experience both the developed and underdeveloped parts and seeing the diff erence in infrastructure, transporta-tion, and access to healthcare has lead me to make addressing these disparities my life’s work.

25

Monisha Ashok graduated from Cal in the Spring of 2009 with a B.A. in Pub-

lic Health and a B.A. in Economics.

Photo by M

onisha Ashok

raw waste than the populations of some U.S. cities produce annually; and many large operations can produce more than 1.6 million tons of manure a year. Bacterial toxins and compounds such as ammonia and hydrogen sulfi de have also been found in wastes generated by CAFOs, and studies have provided documentation of ill health eff ects that workers in the factories as well as people in communi-ties surrounding them have experienced. CAFO workers are exposed to concentrated amounts of manure gases, en-dotoxins, degradation products, and dust on a daily basis, creating a sharp occupational health risk for those who do work inside them.

Nitrogenous run-off from feeding operations can in-fect surface waters, streams and ultimately oceans, causing eutrophication which has infl icted severe harm to several marine ecosystems. � e federal Clean Water Act prohib-its discharges of pollutants from point sources into U.S. waters without a permit; however, according to a report from the Department of Agriculture and U.S. EPA, CAFO muck has still mired about 35,000 miles of rivers in 22 states and groundwater in 17 states. Amazonian rainfor-ests have been cleared at alarming rates as well in order to provide feed for livestock. As one can imagine, the industry has thereby garnered opposition from animal rights activ-ists but environmentalists as well, lambasting the industry for excessive use of natural resources. Th e United Nation’s Food and Agriculture Organization estimates that “70% of previously forested land in the Amazon is used as pasture”, and that livestock production generates nearly a fi fth of the world’s greenhouse gases - exceeding the totality of trans-portation’s own carbon footprint worldwide.

Human health is also at risk because of what is fed to the animals – though much of the food is grain, it may also contain animal waste, animal tissues, and animal by-products. � e process of “rendering” converts animal tissue from deceased livestock, restaurant and butcher shop trimmings, expired meat from groceries, and carcasses of euthanized animals from shelters and zoos into effi cient

Americans consume over 275 yearly pounds of meat per capita – more than any other coun-try in the entire world. Without a doubt, meat itself has become an integral part of our culture

and lifestyle, and one of the driving forces between high rates of obesity and cardiovascular disease. � e correlation between a country’s development and their per capita meat consumption seems logical – meat has a more complex and expensive production process and is more expensive to consumers than other food sources mass-produced and consumed in third world countries. Eff ectively, meat can be seen as a symbol of affl uence and privilege. Th e question is then raised: where is meat taking us?

Undoubtedly, the U.S. meat industry has been the target of a range of attacks from environmental groups, animal rights activists, and increasingly, the general public. A major point of contention is the widespread proliferation of CAFOs, or Confi ned Animal Feeding Operations. Th ey have become a poignant and eff ective symbol for the cause to vegetarianism and veganism. Historically portrayed in the media from a grossly negative standpoint, several fac-tory farms have been exposed as inhumanely overcrowding livestock in inadequate living space, sustaining animals via unnatural alimentation, and essentially creating a inhospi-table space rife with disease and maltreatment. And indeed, these portrayals do possess some truth to them – however, the extent to which such charges of animal cruelty exist among all feeding operations remains yet to be seen due to loose regulation. Th e environmental impact of all CAFOs is regulated at the local, state, and federal levels – chiefl y, the Environmental Protection Agency (EPA). Animal treatment is subject to welfare legislation, though yet again, bureaucratic holes leave gaping ambiguity as to what is ac-ceptable, and according to the Government Accountability Offi ce, legislative oversight is almost non-existent.

Perhaps the most daunting problems factory farms present are the environmental degradation and pollution caused by CAFOs. Some large farms can generate more

26

Marvin So Contributing Writer

What About

MEAT The Cold Cut Facts

Pu

bli

c H

ealt

h A

dvo

cate

contributors to food processing. � e meat and bone meal thereby produced had been fed to cattle for many years, re-sulting in the outbreak of a novel bovine disease, Bovine Spongiform Encephal-opathy. Following several outbreaks in the United Kingdom in the 1980s, this issue was brought to the fore of public dialogue yet again in 2001, when a cow within the U.S. meat industry was found to possess the disease. Human consumption of such infected meat pres-ents a risk in contracting a variant form of the fatal Creutzfeldt–Jakob disease. Eff ectively, developed countries can no longer feed meat and bone meal to other ruminants. However, the meat and bone meal from cattle is fed to non-ruminant animals, and the rendered product from those animals can thus be fed to cattle, in a strange and seemingly paradoxical cycle.

In spite of the controversy sur-rounding it, the fact of the matter is that factory farming presents several benefi ts to both the U.S. economy and its citi-zens. By utilizing government subsidized farming methods, CAFOs can maintain standardized, greater effi ciency and faster treatment of ill animals. Poten-tially, they could employ expert veteri-narians and animal care specialists for on-site care, and contrary to the negative portrayal that many documentaries and undercover reports of industrial facilities have evinced, many do. � ey are able to make regular use of veterinarians and are capable of using advanced antibiot-ics and animal medicine to care for their animals at a level unattainable by most small farms.

Agricultural operations compose an integral fragment of the U.S. economy, and its propagation is one of the main reasons why meat is so aff ordable. With systems of vertical integration and the usage of advanced agri-technology, they can produce food cheaper, enabling cus-tomers to save money on food purchas-es. Meat’s price is, according to analysis by FDA, a vital factor in providing rich protein to many of America’s families.

According to Pennsylvania Secretary of Agriculture Dennis Wolf, “We are see-ing estimates that the annual economic impact per cow is $13,737. In addition, each $1 million increase in Pennsylvania milk sales creates 23 new jobs. � is tells us that dairy farms are good for Pennsyl-vania’s economy.”

Ultimately, changes may have to be made to strike a balance between meat’s commoditization and the need to safe-guard our environment and health. � e organic and sustainable meat market has made strides in recent years to combat the encroachment of industrial meat processing, and has earned a consider-able following among those informed and - more importantly - suffi ciently affl uent. Multiple sources can attest to the meteoric rise of vegetarianism and the fact that meat profi tability has actu-ally been decreasing for several years. Increasingly, consumer awareness has provoked worldwide debate and lobby-ing to remediate the issues the industry presents through stricter policies. Re-search towards in vitro meat - culturing meat tissue without actually having to use a live animal - and other advances in genetic engineering aim to delineate po-tential environmental harm and animal cruelty from industrial animal produc-

27

Over 3 billion pounds of bacon are produced each year in the United States alone. The 2009 out-break of Infl uenza A subtype H1N1, colloquially known as Swine Flu, damaged pork sales considerably.

tion, though the concepts themselves are enough to stir public and political waters.

� e fact of the matter is that the great majority of meat supplying our supermarkets and sitting on our dinner plates comes from CAFOs. Meat is so entwined with rich cultural history and familial celebrations, provides requisite nutrition, and is simply evolutionarily present in most human palettes, that its propagation would appear stable. How that propagation is executed, however, remains yet to be seen. Post-modern agricultural practices, working hand-in-hand with defi ned government oversight and public awareness seem imminently necessitated, but in the end, the great-est power remains vested in consumers’ wallets, and the greatest question - this question of meat - remains on the table.

Marvin So is a 2nd year intended Public Health major and Spanish Lan-guage & Literature minor. His prima-ry interests lie in the community and environmental health of underserved and developing populations. Meaty

comments or questions are welcome at marvinso@berkeley.edu

Photo by: A

lisa Bern T-B

one Source (opposite): w

ww

.therealfoodworld.com

What About

MEAT The Cold Cut Facts

The Medical Marijuana Debate Should we be having one?

32

The issue of drugs in American society has, for many years, been approached by the criminal justice system; however, the medical marijuana debate has shifted marijuana away from the fi eld

of criminal justice and into the public health sector. Dennis Kucinich, U.S. Rep-resentative and can-didate in the 2008 Democratic primary for U.S. President, argued that medial marijuana is “a mat-ter between doctors and patients, and if doctors want to pre-scribe medical mari-juana to relieve pain, compassion requires that the government support that [deci-sion].”

� e concept of using marijuana to treat medical condi-tions has been around for centuries. In 2000 BC, marijuana was used in India, Greece and Rome to treat all forms of pain. In 1839, the fi rst medi-cal article focusing on marijuana was written by William O’Shaughnessy. In 1937, the US Con-gress passed the Mar-ijuana Tax Act, which decreased marijuana usage; by 1941, mari-juana was completely removed from the US Pharmacopeia (the authority regarding what drugs can be prescribed or sold over-the-counter). In 1970 the US replaced the Mari-

juana Tax Act with the US Controlled Substances Act, which classifi ed marijuana as a narcotic with zero medi-cal value. More recently, attitudes have begun to change, once again, as research supporting the medical usefulness of marijuana becomes available. In 1996, California vot-

ers legalized marijuana for medical use. De-spite this step, federal authorities continue to bust marijuana dis-pensaries. Th is Febru-ary, the newly con-fi rmed U.S. Attorney General Eric Holder spoke out against such raids. � e most re-cent policy proposed by the federal govern-ment indicates that medical marijuana will be allowed as long as the dispensaries conform to state laws. It also indicates that cases that involve, vio-lence and minors will be investigated. For years, the federal gov-ernment has refused to acknowledge the validity of state laws that legalize marijua-na. Obama said that, if elected, the federal government would no longer raid medical marijuana dispensa-ries, yet shortly after taking offi ce, four dis-pensaries were raided

in Los Angeles. However, the current administration has fi nally taken its departure from Bush’s hard stance on mari-juana as a harmful narcotic. On October 26, 2009, federal

Celia Bonaduce Contributing Writer

Medical marijuana can provide refl ief to patients, but its effectiveness and necessity remain hotly debated.

Photo by P

eter Hess

3228

Pu

bli

c H

ealt

h A

dvo

cate

33

Celia Bonaduce is a second year Pub-lic Health major. Her academic focus is health policy and management. If you have any questions you can con-

tact her at cbonaduce@gmail.com

medical marijuana policy was reformed and Attorney General Holder told the media ““it will not be a priority to use federal resources to prosecute patients with serious illnesses or their caregivers who are complying with state laws on medical marijuana.”

� e issue of medical marijuana is highly controversial. Questions over safety, eff ectiveness and necessity have been hotly debated for years. Should the United States federal government legalize medical marijuana?

Marijuana is a safe alternative to other pharmaceuticals that can cause harmful side eff ects.

According to Dr. Philip Den-ney, co-founder of a medical cannabis evaluation practice, cannabis is a safe, eff ective and “non-toxic alternative to many standard medications.” He ar-gues that overdose is impossible when using medical marijuana and that there is very low risk of abuse or dependence problems.

On the other hand, many profes-sionals believe that medical marijuana is not safe, both from a medical and a criminal perspective.

According to Dr. Janet Lapey, Ex-ecutive Director of Concerned Citizens for Drug Prevention, Inc., “Marijuana is not the safe drug portrayed by the marijuana lobby. It is addictive; it ad-versely aff ects the immune system; leads to the use of other drugs such as cocaine; is linked to cases of cancer; causes respiratory diseases, mental dis-orders, including psychosis, depression, panic attacks, hallucinations, paranoia, decreased cognitive performance, dis-connected thought, delusions, and im-paired memory.”

According to the Fresno Chief of Police, Jerry Dyer, the legalization of medical marijuana has been “destruc-tive to lives and communities” and its “Passage of any form…anywhere in [the United States] is bad public policy and will cause crime and public safety problems.”

Medical marijuana may cause an increase in drug traffi cking, specifi cally

among teenagers.According to Sue Rusche, Founder

and President of National Families in Action, since the passage of Proposition 215 in 1996, teenage use of marijuana increased by nearly one third, from 6.5% to 9.2%.

Furthermore, some dispensaries may be nothing more than covers for drug traffi cking.

According to the US Drug Enforce-ment Agency, “Today’s enforcement op-erations show that these establishments are nothing more than drug traffi cking organizations bringing criminal activi-ties to our neighborhoods and drugs near our children and schools.”

Medical marijuana eases pain, and works to increase the appetite of those suff ering from AIDS.

According to Dr. Jay Cavanaugh, National Director of the American Alli-ance for Medical Cannabis, “Hundreds of thousands of the sick have replaced disabling narcotics and other psycho-tropic medications with nontoxic and benign cannabis.” He cites patients with spinal injuries who are able to give up using walkers, as well as, AIDS pa-tients sustaining a healthy weight. He has also seen cancer patients fi nd relief from the unbearable nauseas caused by chemotherapy.

While some consider medical mari-juana an eff ective treatment for disease, others argue that medical marijuana has not been thoroughly and satisfactorily tested for proof of medical benefi ts.

According to Dr. Donald Gross, Assistant Professor of Neurology at the University of Alberta, there has yet to be a randomized, controlled trial demonstrating the medical benefi ts of medical marijuana in comparison to currently legal drugs. He argues that medical marijuana is “a product that has been legitimized without any evi-dence of effi cacy.”

� ere is no alternative drug that can replicate the benefi ts of medical marijuana; according to Dr. Gregory T. Carter, Clinical Professor at the School of Medicine at the University of

Washington, Marinol, the most com-monly used medical marijuana substi-tute, only contains one of the benefi cial chemicals found in natural marijuana. Furthermore, Marinol, which comes in pill form, is “the most psychoactive of the cannabinoids and, [yet], is the one that the Federal government allows to be prescribed!”

Although some doctors consider Marinol to be ineff ective, many others prescribe it instead of medical marijua-na. � e medical community has gener-ally accepted Marinol as an acceptable alternative to medical marijuana.

� e medical marijuana debate is politically charged, complicated and controversial. On the one hand, many chronically ill patients are fi nding re-lief to their suff ering as a direct result of medical marijuana. On the other hand, medical marijuana provides drug dealers with easy, legal, access to drugs. � e bottom line is this: medical mari-juana does off er relief to many patients, but the current regulation of medical marijuana is poorly implemented. Ac-cording to Bruce Mirkin, the Director of Communications for the Marijuana Policy Project, “No one wants to see the spirit of [legalization policy] vio-lated or medical marijuana being used as a cover for activities that do not serve patients.” Unfortunately, the gov-ernment’s current medical marijuana policies fall short. Poor regulation not only increases drug traffi cking, but also threatens to derail medical marijuana in its entirety. If the government feels that medical marijuana is increasing drug traffi cking, they are more likely to ban it. Ironically, it is their poor regu-lation that causes the negative eff ects of legalization.

3329

and epidemiology. Dr. Timothy Johnson, the Medical Editor of ABC News, stated that while meteorologists must be educated and receive credentials to report the weather, there is no such credential to be earned for medical journalists. Given this fact, one may be mystifi ed by a public so eager to fully trust the media about medicine, a fi eld in which few reporters have any kind of knowledge.

So how much is the public really infl uenced by the media? Th e National Conference of State Leg-islatures estimated that pharmaceutical companies spend about $2.5 billion every year on advertising. � anks to this large sum of cash, certain drug com-panies and their products have become well known best sellers. A statistic from the National Institute for Health Care Management Research and Education Foundation stated that from 1999 to 2000, the fi fty most advertised drugs increased in prescriptions, and therefore sales, by 24.6 percent. In comparison, in the same year, the sale of all other drugs combined only increased 4.3 percent. Clearly, advertisements have a huge infl uence in the rate of prescriptions written. Th e question is, do doctors write prescriptions for popular drugs over more eff ective drugs? Or are the drugs popular because they’re eff ective?

Many doctors would claim that while older, cheaper drugs may be only 10 percent less eff ective than the much more expensive brand-name drugs, it increases the doctor’s liability if the drug is even slight-ly less eff ective. A patient could sue a doctor for malpractice if they found out a better drug was available to them, when the cheaper drug they were prescribed was not eff ective (if they were part of the 10 percent who found the drug less eff ective.) Another very important infl uence on the doctor’s actions are the demands of the patient. Although it might seem strange that a doctor would prescribe a more expensive drug than the one the patient needs without incentive from a drug company, the patient’s demands can determine a doc-tor’s actions. If someone sees an advertisement for a certain drug on TV and thinks they need that particular drug, they may go to the doctor to ask for it. Even if the doctor does not receive incentive from the drug company, the doctor would have to write the prescription for the patient in or-

Me dicine in the Media:

It is no secret that medical products such as prescrip-tion drugs and medical procedures are constantly in the media. “Breakthrough” medical advances are ex-posed to the public through advertisements, talk

shows, the news, medical journals and other media outlets. � ere are entire magazines dedicated to the newest medical studies and products, such as Health Magazine and Men’s and Women’s Health. Television programs such as Dr. Oz and special segments in regular news shows like the Today Show, discuss many “miracle drugs.” But what exactly is a “miracle drug”, and why are these pills and procedures so prevalent the media today?

Often times the newest drugs on the market, or the most innovative medical procedures, are both very expensive to produce or perform and very expensive to conduct compre-hensive studies and tests on. Older drugs and surgeries have not only been tested in the lab, but they have weathered years of patients’ use. New drugs and procedures, however, have had limited time to provide evidence of eff ectiveness in actual patient use. Pharmaceutical companies spend billions of dollars researching and producing new drugs and prod-ucts, and in order to profi t in the competitive business of medicine, they must prove to the public that their product is the best product, and that it is worth the extra money.

Th e question becomes how exactly do these companies do that? Medical investigative journalist Shannon Brown-lee suggests that the concept of “hiring ghostwriters” is very common among big medical businesses. She explains that this practice includes getting respected physicians to put their name and stamp of approval on a product or having private lab researchers write positive articles in exchange for payment and recognition. Many physicians, on the other hand, deny this idea and claim it is unethical. Brownlee says, however, that almost everything that comes from the media tends to be positive and that there is not enough edu-cated doubt in the press. � is could very well be due to the fact that when one respected physician is bribed to sup-port a certain product, his colleagues respect his opinion and therefore respect the product. � is cycle perpetuates the development of new drugs and procedures that continue to get more expensive.

Also, it should be noted that reporting on medical news requires certain skills and an understanding of biostatistics

30

Pu

bli

c H

ealt

h A

dvo

cate

Me dicine in the Media: Causing More Harm than Good?

31

Sandee Young is a Fourth Year Pub-lic Health Major who will graduate in the Spring. She currently has an internship working with the City of Berkeley Public Health Division and hopes to work for a health publication

after graduation.

der to keep that patient’s business, even if a generic drug would do the same job. Otherwise, that patient may fi nd a diff erent doctor who would write the prescription in order to bring in more patients, which means more profi t.

In the end, there is no such thing as a “miracle drug” and oftentimes, phar-maceutical companies advertise new drugs and procedures as the cure-all for a certain disease or disorder, when this is actually not the case. Although new

technology can be very promising and some new medical products are very ef-fective, many are not any better then the older versions of the drugs, which are much less expensive. � e only way for the consumer to get the most for their money is to observe medicine in the media critically, and always get a second opinion…because that “miracle pill” is not always what it seems.

Photo by A

lisa Bern

To the untrained eye, it is impossible to tell whether these pills are generic, brand name, or even effective at all. Advertisements may make consumers believe they need certain drugs and doctors may feel pressure to prescribe these unnecessary drugs out of fear of losing patients.

Sandee Young Contributing Writer