A monthly radio
magazine devoted to covering major issues in public health.
Produced and hosted by Dr. Marvin Malek, with Dr. Andy Coates, Dr. Gerald Zahavi, and Elaine Hills.
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#83 (December 2007)
the Public Health Radio Archives: a re-broadcast of "THE
HEALTH CARE SAFETY NET, PART ONE: THE FREE CLINICS IN THE
STATE OF VERMONT: ACHIEVEMENTS AND REMAINING CHALLENGES IN
PROVIDING HEALTH CARE FOR THE UNINSURED. [MP3]."
all the other developed nations, the United States has allowed
a large portions of its population-about 44 million individuals,
according to the US Census-to go without health insurance.
The high prices of medical care make it difficult for these
individuals to seek care at most doctors offices and hospitals.
A number of institutions-all with varying degrees of public
funding-are specifically designed to address the health
care needs of the poor and uninsured. Taken together, these
institutions are referred to as the health care safety net.
One key safety net institution is the 800
free clinics that have sprouted up across the United States.
Because Vermont has only one community health center and
no public hospitals, its nine free clinics serve a uniquely
important role. In show #35 we interview free clinic volunteers,
staff, and patients to provide a special documentary edition
of Public Health Radio. Their experiences provide insights
into the achievements and limitations of the services that
free clinics are able to offer their patients.
Relevant websites include the National
Association of Free Clinics http://www.freeclinics.us/ and
the Vermont Coalition of Clinics for the Uninsured: http://www.vccu.net/.
#82 (November 2007)
ENVIRONMENT AND PUBLIC HEALTH: THE EFFECTS OF URBAN DESIGN
AND TRANSPORTATION SYSTEMS ON COMMUNITY HEALTH [MP3]
This is -- with the exception of the news segment -- a re-broadcast of an earlier show.
The built environment—especially metro
areas’ transportation and urban designs--have enormous
impacts on public health--whether the issue is air pollution,
traffic safety, or obesity. But when developers are designing
new neighborhoods, and when public officials are crafting
zoning regulations, they rarely consider what consequences
their plans might have on the health of the community. Similarly,
when metropolitan areas are planning transportation systems,
the public health effects of their transportation plans are
not a major consideration. The September, 2003 issue of the
American Journal of Public Health was exclusively devoted
to the issue of how the urban and suburban community design
affects public health. The guests on this show--Howard Frumkin
and Elliott Sclar--were two of the editors of that issue,
and they join us to discuss the effect of built environment
on public health. . During the discussion, we also look at
some of the fiscal and political obstacles preventing the
creation of an environment that fosters public health
Howard Frumkin chairs the Department of Environmental and
Occupational Health at Emory University, School of Public
Health in Atlanta. Dr. Frumkin was named to EPA’s Children’s
Health Protection Advisory Committee in 2001, where he chaired
the Smart Growth work group. He serves as a Board member of
the state of Georgia’s Clean Air Campaign. He currently
serves on the Institute of Medicine Roundtable on Environmental
Health Science. He is author of a recently released book titled
Urban Sprawl and Public Health, available through
Island Press. Elliott Sclar is Professor of Urban Planning
and Public Affairs at Columbia University. He is a leading
figure in the scholarly movement to reconnect the work of
population health experts and urban planners in creating healthier
cities. Professor Sclar has studied and written extensively
on the economic, political and social forces that drive actual
metropolitan land use decisions. While much of his attention
has been focused on the United States, he recently was honored
by his selection as Co-Coordinator of the United Nations Millenium
development project taskforce addressing the health, environmental
and economic impacts of rapid urbanization in the poor countries
of the Global South.
The website of the Centers for Disease Control and Prevention
provides useful information on the road to urban and transportation
plans that foster public health. The website is: http://www.cdc.gov/node.do/id/0900f3ec8000e044
— click onto the environmental health section of the
website, which lays out health impacts of built environment.
Smart Growth America is a coalition of groups which advocate
for health-promoting growth that supports the local economy
yet protects the environment. The web address is http://www.smartgrowthamerica.com.
Finally, the Surface Transportation Policy Partnership helps translate
the issues addressed on today’s show into the arena
of legislation and policy. On the web, the project is found
Program #81 (October 2007)
"PUBLIC HEALTH AND INCARCERATION IN AMERICA [MP3]."
Dr. Marvin Malek interviews Dr. Richard Dudley, a founding member of the Commission on Safety and Abuse in America’s Prisons, about the public health aspects of incarceration in the U.S.
Program #80 (September 2007)
"ABORTION AND UNINTENDED PREGNANCIES (PART 2) [MP3]."
This is part 2 of Dr. Marvin Malek's examination of abortion and unintended pregnancy -- begun last month. In this segment Dr. Malek speaks to the Chair of the Adolescent Health Policy Committee of the American Academy of Pediatrics, an opinion researcher who specializes in reproductive health issues, and two pro-life activists -- to determine if common ground is possible in the current abortion debate.
Program #79 (August 2007)
"ABORTION AND UNINTENDED PREGNANCIES (PART 1) [MP3]."
Dr. Marvin Malek interviews Dr. Jacqueline Darroch on abortion and unintended pregnancy.
Program #78 (July 2007)
"IN THE EPICENTER OF THE HIV PANDEMIC: PATRICIA SIPLON'S REFLECTIONS ON LIFE IN TANZANIA [MP3]."
According to data from United Nations AIDS program, approximately 40 million people are currently infected with the HIV virus, roughly 95% of them in the poor countries of the global South.
Over 3M people worldwide are dying of HIV infection every year-over 1/2 M of them are children. Since the onset of the epidemic 2 decades ago, 20M people have died in sub-Saharan Africa alone, the epi-center of the HIV pandemic. The number of AIDS deaths in Africa will soon surpass the 20 million people who died of the Black Death during the 14th century. AIDS is expected to slash overall economic activity in Africa by 25%.
Those colossal numbers can seem overwhelming and the individuals who are impacted can feel very distant to those of us who live in the United States. But we in the US are more connected to the tragic situation in sub-Saharan Africa than we may think-US government policies ranging from agricultural subsidies to policies at the International Monetary Fund, as well as our response to the nursing shortage in the US all have palpable impacts on Africa-and no area of the world has been more adversely affected by global warming than southeastern Africa.
Dr. Patricia Siplon describes her experiences with the HIV epidemic in Tanzania, the many ways that we in the US are directly connected to the suffering in Tanzania, and what listeners can do to promote health and development in sub-Saharan Africa.
Patricia Siplon has explored the public health and economic crises in sub-Saharan Africa both in her work as a political scientist and directly in the development work she is doing in Tanzania. Dr. Siplon is an Associate Professor of Political Science at St. Michael's College in Vermont.. She has written many books and other publications on HIV-related policy and other development issues, highlighting the role women play both in their economies and in the HIV epidemic. She has won numerous awards, including a Fullbright Fellowship in pursuit of her activities in Africa. In Tanzania, Dr. Siplon has provided technical support for several organizations advocating for people impacted by HIV. Recently, the Clinton Foundation funded a grant she developed to promote the expansion of the Ilula Orphan Program, a project that supports orphans of the HIV epidemic in central Tanzania.
The Ilula Orphan Program's new website can be accessed at www.ilulaorphanprogram.org. Donations to the program are enormously helpful, especially to become a sustainer who supports a child's education on an ongoing basis. The Health Global Access Project is one of the leading activist organizations working to improve health systems in the Global South, with a particular emphasis on the needs of HIV infected individuals in sub-Saharan Africa. Website is www.healthgap.org.
Program #77 (June 2007)
LOOK AT HOMELESSNESS IN THE UNITED STATES: IMPACTS ON HEALTH,
AND THE CHALLENGES INVOLVED IN PROVIDING MEDICAL SERVICES TO HOMELESS
On Show #77, Jeff Singer
and Jim O’Connell join us to discuss the public health impacts
of homelessness. Both have devoted their careers to understanding
the health problems of the homeless and providing medical and
mental health care to them
Jeff Singer is the
President & CEO of Health Care for the Homeless of Maryland.
A clinical social worker, he has worked mental health and addiction
services, and doing street outreach and community organizing since
1969. Singer also chairs the Policy Committee, and has served
as President of the National Health Care for the Homeless Council,
the organization which represents 187 homeless health care agencies
throughout the U.S. In these roles, Mr. Singer has been involved
in developing and advocating for national policies and programs
related to homelessness, health care, housing, and poverty.
received his training in internal medicine at Massachusetts General
Hospital in 1985, and became the founding physician of the Boston
Health Care for the Homeless Program, and has served as its President
for over 10 years. Three years after its founding, the project
was accepted among the first group of federally funded homeless
healthcare delivery programs. O’Connell has overseen the
development of a citywide service delivery network that has emerged
as a national model. Multidisciplinary teams conduct daily clinics
at three academic medical centers and provide care to the homeless
at over 70 sites in metropolitan Boston, including homeless shelters,
soup kitchens, transitional programs, detoxification units, a
local thoroughbred racetrack, and directly on the streets. Throughout
the entire 22 years in the project, O’Connell has juggled
an active role in the strategic direction of the program with
direct clinical work as an internist providing patient care to
Boston’s homeless population.
on the issues homeless Americans face, services available to assist
the homeless, and policy and advocacy positions are available
online at the National Health Care for the Homeless Council, http://www.nhchc.org.
The federal Health Care for the Homeless program, run through
the Health Resources and Services Administration, can be accessed
. Information on Baltimore’s homeless health is online at
http://www.hchmd.org, and the website of the Boston Health Care
for the Homeless Program is http://www.bhchp.org.
Program #76 (May 2007)
HEALTH AND COAL [MP3]."
Elaine Hills interviews
Jeff Goodell on the public health hazards associated with the
Coal has a rich history in the public health sphere, as it has
long been associated with a host of health and environmental problems.
By the mid-20th century, the toxic power of coal pollutants was
witnessed by the world as Donora, Pennsylvania and London, England
experienced air pollution inversions that resulted from a heavy
concentration of coal power production pollutants that hovered
overhead and ultimately killed thousands. Despite the long history
of deaths and health problems resulting from coal, it remains
a widely used energy source—and in many areas of the world today
coal use is on the rise. But the health effects of coal have certainly
not diminished since the early, dark days of coal. The day-to-day
operations of coal mining are dangerous to say the least, for
mine workers and the communities they mine and live in. We now
associate coal with some of the world’s worst job conditions,
as evidenced in all-too-frequent news reports of devastating coal
mining accidents. Modern practices of blasting apart mountaintops
to access the remaining coal in the Appalachian region of the
United States (U.S.), where the preponderance of U.S. coal is
mined, has resulted in pollution of hundreds of stream miles and,
in some cases, black sludge spewing from the faucets of area residents.
The hazards of coal are also felt by our wider society. In recent
decades public health researchers have clearly documented connections
between the air pollutants produced by coal and a range of health
effects including premature mortality, stunted growth in children,
and increased incidence of asthma attacks. Coal power plants are
also a major emitter of carbon dioxide, the greenhouse gas most
widely known for producing climate change. The United Nations
Intergovernmental Panel on Climate Change reports that to reduce
the speed at which humans change the global climate we must decrease
our dependence on coal for electricity production. Yet half of
the electricity produced in the U.S. alone comes from coal.
Author and journalist Jeff Goodell joins us on public health radio
program #76 to explore the intersection of coal and public health.
Jeff is a contributing editor at Rolling Stone and a
frequent contributor to the New York Times Magazine.
He is the author of two in-depth and important books about the
coal industry, including the New York Times bestseller
Our Story: 77 Hours That Tested Our Friendship and Our Faith
, which was published in 2002 and based on the terrifying hours
nine Quecreek miners spent trapped underground. His most recent
book, Big Coal: The Dirty Secret Behind America’s Energy Future,
published in 2006, reveals what Jeff calls “our shiny white iPod
economy propped up by dirty black rocks.” We will spend the hour
with Jeff, discussing the depths of coal’s impacts on public health,
and just what the stakes are as the world ramps up its dependence
on coal, the Bush administration weakens public health regulations
of the coal industry domestically, and the world faces a host
of challenges to meet the energy demands of a growing and modernizing
population in the era of global warming.
Program #75 (April 2007)
DRUG PRICES AND AIDS MEDICATIONS [MP3]."
guest, Prof. Brook K. Baker, is Professor of Law at Northeastern
University School of Law in Boston, MA. He is an expert on the
structural determinants of the global HIV/AIDS pandemic and the
policies and practices that limit treatment access.
Program #74 (March 2007)
YEARS AFTER THE INVASION: PUBLIC HEALTH AND MEDICAL CARE IN OCCUPIED
have passed since the US invaded Iraq on March 20, 2003. Unfortunately
for both Iraq and the US, the initial conquest of the country
has proven to be far simpler than maintaining security and social
cohesion. While the ongoing insurgency and civil war have received
abundant media coverage, the state of public health in Iraq has
received little attention. Iraq's once proud health system, which
boasted high quality care and free, universal coverage has been
decimated. Unique among countries in the region, infant mortality
and child survival have both worsened over the last 15 years.
Dahr Jamail joins us to provide an update on
his groundbreaking 2005 report on the crisis in Iraq's hospital
sector, the reasons for the decline of Iraq's hospitals and health
care infrastructure, and the severe "brain drain" that is occurring
as large numbers physicians, nurses and other health care workers
flee the country. He describes the frequent attacks the US military
has made on Iraq's hospitals and health workers during conflict
situations. Jamail also describes the ineffective effort to resuscitate
Iraq's infrastructure: Efforts at reconstruction have been hobbled
by the US government's insistence on privatization, fraud and
corruption among both US and Iraqi contractors, and the pernicious
impact of insecurity, as the country is beset with rampant crime,
civil war, and insurgency.
Jamail is a young journalist who decided to dive into
journalism in 2003 with one of the most important, difficult,
and dangerous assignments in the modern history of journalism:
Serving as a correspondent in war-torn Iraq. Unlike most journalists
covering the war, Jamail has steered clear of the influence-and
the safety-of the US military, and instead has chosen to embed
himself with the citizens of Iraq to learn about the daily struggles
they face. His dispatches were quickly recognized as an important
media resource. He is now writing for the Inter Press Service,
The Asia Times, and his reports have been translated
into a dozen languages.
Jamail's report, "Iraqi Hospitals Ailing Under Occupation"
and numerous other reports on Iraq are available at Dahr Jamail's
Information on child health in Iraq is available at the UNICEF
website : http://www.unicef.org.
The World Health Organization's website: http://www.who.int
also contains useful information on public health in Iraq.
#73 (February 2007)
MASSACHUSETTS AND CALIFORNIA HEALTH REFORM PROPOSALS: IS
MEANINGFUL HEALTH REFORM OCCURRING AT THE STATE LEVEL? [MP3]."
after year, the US health care system continues to perform
poorly. We have worse public health outcomes than most every
other developed country as measured by life extentancy,
disability rates, infant mortality, and many other measures.
Year after year, we spend double the per capita spending
of the average for the other developed countries. And while
in every other developed nation, every citizen has comprehensive
health coverage, here in the US the quality of coverage
for most Americans worsens each year, with most Americans
experiencing every higher deductibles, copays and coverage
exclusions. And a growing number of Americans have no coverage
at all--the number currently exceeds 47 Million.
Despite this stunning degree of dysfunction, the issue of
health care had hardly been mentioned by the Bush administration
in its first 6 years. Faced with apparent neglect nationally,
more and more states are attempting to solve some of the
problems in the US health care system by proposing state-based
Among the various states that have enacted reforms of their
health systems, the mainstream press and pundits across
the US have characterized the plan proposed by Governor
Schwarzeneggar in California and the plan passed into law
in Massachusetts as especially significant achievements
that will move the United States much closer to achieving
universal health care. David Himmelstein and Judy Dugan
join us on Show #73 to examine these health reform plans,
as well as the health reform proposal President Bush announced
in his State of the Union message.
David Himmelstein, MD is a practicing internist, an Associate
Professor of Medicine at Harvard Medical School, and Chief
of the Division of Social and Community Medicine at Cambridge
Hospital. He has published more than 100 journal articles
and three books. Much of his research focuses on access
to medical care, medical bankruptcy, and the feasibility
of national health insurance. In 1987, he co-founded Physicians
for a National Health Program, a national organization with
over 14,000 health care workers that advocates for a single
payer, universal health care system for the United States.
Judy Dugan is the Director of Research at the Foundation
for Taxpayer and Consumer Rights. Her research areas have
focused on health insurance and oil industries. The Foundation
for Taxpayer and Consumer Rights is a non-partisan consumer
watchdog group based in Santa Monica, California, that works
to enhance the impact of citizens on state governments,
especially in California, and focuses especially on the
insurance and energy sectors.
Information on the Massachusetts reform bill is available
at the website of the Commonwealth Health Insurance Plan
through the state's website http://mass.gov. Some commentary
on the Massachusetts plan, and further information on Physicians
for a National Health Program can be accessed through the
PNHP website http://www.pnhp.org.
Governor Schwarzeneggar's health reform proposal is summarized
in the following pdf file: http://gov.ca.gov/pdf/press/Governors_HC_Proposal.pdf.
The Foundation for Taxpayer and Consumer Rights' website
includes ample information and commentary on health reform
in California [http://www.consumerwatchdog.org.
#72 (January 2007)
CARE AND BANKRUPTCY [MP3]."
is -- with the exception of an updated News segment -- a
repeat of a previous broadcast: "MEDICAL BANKRUPTCY
& THE HEALTH CARE SAFETY NET: FINANCIAL IMPACTS OF POOR
MEDICAL COVERAGE IN THE UNITED STATES." Elizabeth Warren
joins us to discuss the high frequency with which illness
and medical costs lead to bankruptcy in the United States.
Researchers at the Institute of Medicine have estimated
that approximately 18,000 extra deaths can be attributed
to lack of health insurance in the US each year. But far
less attention has been paid to the distress and financial
struggles brought about by gaps in the US health insurance
system. This has occurred even when there are no documented
deaths or other adverse health outcomes in these families.
And these struggles frequently occur among families which
do have health insurance coverage. The absence of previous
research on financial distress brought on by poor insurance
coverage led to a great deal of media attention to Elizabeth
Warren's article on medical bankruptcy. The study is available
online under "web exclusives" at the Health Affair's website,
which is http://healthaffairs.org Elizabeth Warren, JD is
the Leo Gottlieb Professor of Law at Harvard Law School.
The has been a Professor at Harvard Law School since 1995,
and was previously on the law faculty at the University
of Pennsylvania and University of Texas. Professor Warren
is a nationally recognized expert in the area of bankruptcy.
She has published numerous books and articles in the area
of bankruptcy law, and the many social, personal, and familial
impacts of debt and bankruptcy.