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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Program #35 (December 2003) 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]. {A special Public Health Radio documentary} Show #35 is the first in a two part series on the health care safety net in the United States. Unlike 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.nafclinics.org/ and the Vermont Coalition of Clinics for the Uninsured http://www.vccu.net/. Other relevant websites are listed under Show #36.

Program #34 (November 2003) INCINERATION OF PLASTIC, RUBBER, AND MUNICIPAL AND MEDICAL WASTE: PUBLIC HEALTH IMPACT, AND THE AVAILABILITY OF ALTERNATIVES TO INCINERATION. [MP3]. This show explores the public health impacts of incineration. We look at the incineration of rubber and tire fragments, of municipal waste, and also of medical waste. Our guests review the array of substances that exit the smokestacks of incinerators, their impacts on human health. Finally, we discuss some alternatives to incineration. Our guests are Paul Connett, Jorge Emmanuel, Peter Orris and Neil Carman. Paul Connett is a Professor of Chemistry at St. Lawrence University in Canton, NY. His research has focused on the interactions of heavy metals and dioxins with biological systems, and the physical chemistry of waste incineration. Jorge Emmanuel is a chemical engineer, specializing in medical waste management. He is currently one of two lead consultants to the World Health Organization on a project to reduce medical waste incineration in developing countries. Neil Carman is a biologist who worked for many years at the Texas Air Control Board, the primary agency which investigates and regulates air pollution in the state of Texas. Dr. Carman currently serves as Senior Scientist at the Lone Star Chapter of the Sierra Club. Peter Orris, MD MPH is a medical doctor specializing in Occupational Medicine, and Professor of Environmental and Occupational Health at the University of Illinois at Chicago. The Agency for Toxic Substances and Disease Registry, a branch of the Centers for Disease Control and Prevention, collects and disseminates scientific information about the health effects of industrial and residential chemicals and other substances which have toxic potential. The website is: http://www.atsdr.cdc.gov/. Health Care Without Harm is an international organization which disseminates information about the public health impacts of the incineration of medical waste. Website is: http://www.noharm.org/medicalWaste/issue. The Global Alliance for Incinerator Alternatives promotes alternative technologies to municipal and medical incineration. http://www.no-burn.org/

Program #33 (October 2003) EMERGENCY CONTRACEPTION: WHAT IS AVAILABLE FOR POST-COITAL CONTRACEPTION & WHY SO FEW WOMEN ARE TAKING ADVANTAGE OF IT. [MP3]. Heather Boonstra and James Trussell join us to discuss Emergency Contraception. Emergency Contraception is a medication that is taken within three days after intercourse when there was a suspected failure of contraception. Despite its track record of minimal side effects, and about 88% effectiveness at preventing pregnancy, emergency contraception has received virtually no publicity in the US, and little more than 10% of women of reproductive age are familiar with it. Most experts estimate that half of the 1,000,000 abortions that occur in the US each year would be prevented if knowledge of emergency contraception were widespread, and the medication were readily available at all pharmacies. Heather Boonstra is a Senior Policy Associate at the The Alan Guttmacher Institute. http://www.guttmacher.org She earned a Masters Degree in Religion and Medical Ethics from Yale University, and has worked as a consultant in international population and family planning with the Center for International Health and Information. James Trussell is Professor of Economics and Public Affairs and Director of the Office of Population Research at Princeton University. He is the author or co-author of nearly 200 scientific publications, primarily in the areas of reproductive health and demographic methodology, and emergency contraception has been one important research focus. He maintains an emergency contraception website (not-2-late.com) and designed and launched a toll-free emergency contraception hotline (1-888-NOT-2-LATE). FEMALE SEXUAL DYSFUNCTION: THE CREATION OF A DIAGNOSIS FOR THE SAKE OF DRUG INDUSTRY PROFITABILITY Pharmaceutical companies have been scrambling to find a female equivalent of Viagra, the enormously profitable blockbuster drug that has revolutionized the treatment of erectile dysfunction in men. However, thus far, the drug industry has not only failed to identify a single medicine that effectively improves female sexual response, but Leonore Tiefer, guest on this edition of Public Health Radio asserts that Female Sexual Dysfunction does not even meet any of the usual criteria of a disease syndrome. Further information can be obtained at http://www.fsd-alert.org Leonore Tiefer, PhD is a sex therapist and an expert in the field of female sexual dysfunction. She serves as a Clinical Associate Professor in the Department of Psychiatry and Behavioral Sciences at Albert Einstein College of Medicine.

Program #32 (September 2003) TERRORISM AND PUBLIC HEALTH. [MP3]. Barry Levy and Victor Sidel discuss their recently released book, Terrorism and Public Health (Oxford University Press, New York, http://www.oup-usa.com ). During the interview, we review the chronology of events that faced the New York City Dept of Health after the terrorist attacks, the anthrax scares that followed, and address the importance of public health in the defense against terrorism. Barry Levy MD MPH practices in the field of occupational and environmental health, and is on the faculty of Tufts University School of Medicine. Victor Sidel MD is Distinguished University Professor at Albert Einstein College of Medicine. Both are founding members of the IPPNW, the organization that won the 1985 Nobel Peace Prize, and both are past Presidents of the American Public Health Association. TWO YEARS AFTER 9/11: PUBLIC HEALTH AND THE DEFENSE AGAINST TERRORIST ATTACK Public Health Radio host Marvin Malek reviews the Bush administration's approach to terrorism two years after the 9/11 terrorist attacks. Liabilities of an "offensive" approach to terrorism are highlighted, as is the relative neglect of defensive assets, such as the public health sector.

Program #31 (August 2003) THE PHYSICIANS' PROPOSAL FOR A NATIONAL HEALTH PROGRAM. [MP3]. MAIN SEGMENT: A CONVERSATION WITH GARRY DENNIS, QUENTIN YOUNG, AND RON ANDERSON ABOUT THE PHYSICIAN'S PROPOSAL FOR A NATIONAL HEALTH PROGRAM. To promote the cause of universal health care, a prestigious group of physicians developed a proposal for a universal health care system that patterns itself on the systems in Canada, Australia, and other developed countries. It was published in the Journal of the American Medical Association, the most widely circulated medical journal in the US. The proposal was endorsed by nearly 10,000 physicians. The physicians propose a tax financed system, in which health insurance funds in each state would pay for all needed medical care. Because all citizens, and virtually all medical care would be paid for out by these state insurance funds, the private health insurance companies would become obsolete if the proposal were enacted. The physicians estimate that despite generously funding health services without deductibles or co-payments for every US citizen, the system would not cost more than we are currently spending on health care. Savings in the proposal come from eliminating the massive administrative costs imposed by the private health insurance system, by efficient regional planning of health services, and by discounts obtained from bulk purchasing of prescription drugs and other medical supplies. The proposal is available on the web at physiciansproposal.org. Garry Dennis is the Chief of the Division of Neurosurgery at Howard University College of Medicine in Washington, DC, and is a past President of the National Medical Association. Quentin Young is a Clinical Professor of Preventive Medicine at the University of Illinois Medical Center, a Past President of the American Public Health Association, and, for 10 years, has served as the National Coordinator of the Physicians for a National Health Program, an organization that has been in the forefront of the struggle for universal health care. Ron Anderson is President and Chief Executive Officer of Parkland Health and Hospital System, in Dallas, TX, one of the largest public hospitals in the country.

Program #30 (July 2003) Public Health in Afghanistan, Part II / Judy Wilkenfeld Discusses the Final Stage of the World Health Organization's International Negotiation to Limit the Spread of Tobacco Addiction into the Poorer Contries of the Global South. [MP3]. SEGMENT 1: PUBLIC HEALTH CRISIS IN AFGHANISTAN: REPORT FROM THE FRONT LINE: PART 2 Annalies Borrel and Peter Salama discuss the many elements contributing to the crisis in public health in war-ravaged Afghanistan. These include the drought and crop failure, high rates of infectious diseases, poor access to reproductive health services, and high rates of disability due to war injuries and landmines. Drs. Salama and Borrel also discuss the development efforts underway to address these public health issues. This portion of the interview (Part 2) focuses especially on the impacts of war and landmines, drugs and HIV, and the redevelopment effort. Peter Salama, MD, serves in Afghanistan as the Chief of Health and Nutrition for UNICEF Afghanistan. In that capacity, he is resonsible for the design and implementation of UNICEF's largest health and nutrition program. Annalies Borrel currently serves as the Senior Food Security and Nutrition Adviser for the Afghani Ministry of Health, and is also on the UNICEF Afghanistan staff. SEGMENT 2: COMPLETION AND ACCEPTANCE OF THE INTERNATIONAL TOBACCO TREATY AT THE WORLD HEALTH ORGANIZATION Judy Wilkenfeld provides an update on the final rounds of the treaty negotiation to limit the spread of tobacco addiction into the poor countries of the Global South. The treaty negotiation, known as the "Framework Convention on Tobacco Control", was convened by the World Health Organization. She comments on the likelihood of ratification in the US, and the probable overall impact of the treaty. Judy Wilkenfeld leads the activities of the Center for Tobacco Free Kids' to monitor, publicize, and strengthen the tobacco control treaty.

Program #29 (June 2003) Public Health in Afghanistan, Part I / Maine's Drug Prescription Program / Commentary on Maine and the World Health Organization [MP3] [MP3]. SEGMENT 1: PUBLIC HEALTH CRISIS IN AFGHANISTAN: REPORT FROM THE FRONT LINE (PART 1) Annalies Borrel and Peter Salama discuss the many elements contributing to the public health crisis in war-ravaged Afghanistan. These include drought and crop failure, high rates of infectious diseases, poor access to reproductive health services, and high rates of disability due to war injuries and landmines. Drs. Salama and Borrel also discuss the development efforts underway to address these public health issues. This portion of the interview (Part 1) focuses provides an historical context for the current crisis, and describes agriculture and malnutrition, and problems in maternal and child health in Afghanistan. Peter Salama, MD, serves in Afghanistan as the Chief of Health and Nutrition for UNICEF Afghanistan. In that capacity, he is responsible for the design and implementation of UNICEF's largest health and nutrition program. Annalies Borrel currently serves as the Senior Food Security and Nutrition Adviser for the Afghani Ministry of Health, and is also on the UNICEF Afghanistan staff. SEGMENT 2: MAINE Rx: THE RATIONALE AND HISTORY OF THE STATE OF MAINE'S EFFORT TO REDUCE PRESCRIPTION DRUG PRICES Kevin Concannon discusses the mechanism used in the Maine Rx law, passed in May, 2000, and provides some of its history. After prolonged appeals and legal challenges by the drug industry, Maine Rx Law was upheld by a 6 - 3 vote in the US Supreme Court in May, 2003. Mr. Concannon provides the context in Maine: A poor state with strong connections to Canada, in which thousands of citizens cannot afford the medicines their doctors are prescribing. There was strong public support for an activist administration to develop a program to lower prescription drug prices for the 330,000 residents of Maine who have no form of prescription drug insurance coverage. Kevin Concannon was the Commissioner of the Department of Human Services in the state of Maine from 1995 through February, 2003. He led the Maine Rx initiative for the state government in Maine. He currently serves as the Director of the Iowa Department of Human Services. COMMENTARY: TWO PUBLIC HEALTH ACHIEVEMENTS DURING MAY, 2003 Public Health Radio host Marvin Malek discusses the patience and persistence needed to achieve two important milestones which occurred during the previous month: The victory in the US Supreme Court of the Maine prescription drug program, and the victory at the World Health Organization of tobacco control advocates in achieving a strong treaty agreement to limit the spread of tobacco addiction into the poor countries of the Global South.

Program #28 (May 2003) International Trade Negotiations in Health Services / Military Health Programs in the US [MP3]. Main Interview: PROGRESS OF THE WTO NEGOTIATIONS TO REDUCE BARRIERS TO TRADE IN HEALTH SERVICES & IMPACTS OF FREER INTERNATIONAL TRADE ON HEALTH CARE SYSTEMS. Debra Lipson discusses the progress of negotiations convened by the World Trade Organization to reduce barriers to international trade in health services, and factors that influence the trade negotiators. She also looks at a variety of impacts of reduced trade barriers on availability of health insurance and health care services, especially in less developed countries. Debra Lipson worked at the World Health Organization until 2001. A key responsibility she held was to evaluate the impacts of international trade on health care systems. She is currently Deputy Director of the Better Jobs Better Care Program at the Institute for the Future of Aging Services. Commentary: SUPPORTING OUR TROOPS: CURRENT STATUS OF MILITARY HEALTH PROGRAMS IN THE UNITED STATES. Public Health Radio host Marvin Malek discusses the crisis facing the Veterans Administration system as well as Tricare, the health insurance program which provides health insurance for 8 million military families and retirees. He also explores some impacts of recent policy changes in the Department of Veterans Affairs and in the Tricare program.

Program #27 (April 2003) NICOTINE REPLACEMENT SYSTEMS IN VERMONT / MEDICAID REFORM / URANIUM IN VERMONT WATERS [MP3]. Main Interview: THE BUSH ADMINISTRATION PROPOSAL TO REFORM THE MEDICAID PROGRAM Dennis Smith and Leighton Ku discuss the Bush administration's proposal to reform the Medicaid program. Currently, the federal government provides matching funding to supplement state Medicaid spending. President Bush has proposed to replace this with a block grant funding structure. Critics are concerned that the proposal eliminates the incentive the states currently have to broaden Medicaid coverage, and also that the administration has not responded to the widespread state budget crises and increase in the uninsured population brought on by the current economic slowdown. Dennis Smith is the Director of the Center for Medicaid and State Health Programs at the Department of Health and Human Services, appointed by President Bush in July, 2001. Leighton Ku is a Senior Policy Analyst at the Center for Budget and Policy Priorities. Segment 2 : THE PRESENCE OF NATURALLY OCCURRING RADIOACTIVE ELEMENTS IN DRINKING WATER Larry Becker discusses the recent finding of elevated levels of naturally occurring uranium in the drinking water of Marshfield, VT. The discussion includes the distribution and stability of radioactive isotopes in drinking water, and availability of testing. Larry Becker is the Vermont State Geologist and directs the Vermont Geological Survey. Segment 3 :GOVERNMENT SUBSIDY OF NICOTINE REPLACEMENT SYSTEMS Karen Garbarino discusses the use of nicotine replacement systems in quitting tobacco smoking, and recently enacted programs in Vermont and New York City to subsidize the cost of nicotine replacement patches and gum products.

Program #26 (March 2003): ORAL HEALTH IN AMERICA: A PUBLIC HEALTH OUTLOOK ON DENTISTRY AND ORAL HEALTH IN THE US [MP3]. Interviews: Alice Horowitz and Myron Allukian provide a public health outlook on the magnitude of oral health problems in the United States. They highlight major advancements, such as water flouridation and dental sealants. They also discuss the gaping disparities in dental care experienced by the poor and near-poor in the US, and available solutions, as well as obstacles to progress in oral health Myron Allukian is the Director of Oral Health for the Boston Public Health Commission. Dr. Allukian is a past president of the American Public Health Association (APHA), only the second dentist to have achieved that honor. Alice Horowitz is the Senior Scientist for Health Policy Analysis and Development at the National Institute for Dental and Craniofacial Health. Commentary: PRESIDENT BUSH'S PROPOSAL TO INCREASE FUNDING FOR THE INTERNATIONAL HIV EPIDEMIC: OPPORTUNITIES AND OBSTACLES Paul Zeitz discusses President Bush's proposal to triple US funding directed toward the HIV epidemic in the Global South. Zeitz points out the positive impact of the president's willingness to highlight the HIV epidemic, but the disappointment brought about by the backloading of funding, and the president's preference to distance the US from the UN Fund for HIV, Tuberculosis and Malaria in his funding proposal. Dr. Paul Zeitz is the Executive Director of the Global AIDS Alliance, an alliance of organizations working to control the HIV epidemic across the globe.

Program #25 (February 2003): GE Work Stoppage and Health Care & Medicalization of Menopause [MP3]. Interviews: 1) THE GE WORK STOPPAGE AND THE FUTURE ROLE OF ORGANIZED LABOR IN THE MOVEMENT FOR UNIVERSAL HEALTH CARE IN THE US James Weldon discusses the GE work stoppage as an example of the increasing attention health insurance has received in contract negotiations. He discusses the evolving attitude of organized labor toward the movement for national health insurance. James Weldon is the Business Manager of Local 728 of the International Brotherhood of Electrical Workers, building trades workers in Southeastern Florida. 2) THE MEDICALIZATION OF MENOPAUSE AND THE FINDINGS OF THE WOMEN'S HEALTH INITIATIVE Amy Allina discusses the recent findings of the Women's Health Initiative, a major NIH-funded study which demonstrated that combined estrogen-progestin therapy increases long-term health risks in previously healthy women. She analyzes the reasons why the study's findings surprised many physicians, and the role of the pharmaceutical industry in influencing the prescribing behavior of physicians and women's understanding of how best to traverse the menopausal period in the healthiest possible way. Amy Allina is the Program and Policy Director of the National Women's Health Network, a research and advocacy organization that focuses on women's health. She is co-author of The Truth about Hormone Replacement Therapy: How to Break Free from the Medical Myths of Menopause. Commentary: POLITICIZING OF APPOINTMENTS TO FEDERAL SCIENTIFIC ADVISORY PANELS: THE CASE OF PHARMACEUTICALS OF SIGNIFICANCE TO WOMEN'S HEALTH Amy Allina provides an opinion piece on the importance of maintaining basic qualifications for appointees to scientific advisory panels. As a case study, she uses a recent Bush administration appointee to the Food and Drug Administration advisory panel on drugs of significance to women's reproductive health.

Program #24 (January 2003): Public Health and Privatizing Ghana's Water Supply [MP3]. Interview: ACCESS TO SAFE WATER IN GHANA: THE IMPACT OF WORLD BANK POLICIES. Ellen Shaffer and Joseph Brenner discuss the proposal advanced by the World Bank to privatize Ghana's urban water supply. Implications for availability of safe water and sanitation are discussed. The rationale and implications of World Bank and IMF structural adjustment programs on the public health is also addressed. Ellen Shaffer is an Assistant Professor of Clinical Pharmacy at the University of California at San Francisco, and Co-Director of the Center for Policy Analysis on Trade and Health. Joseph Brenner works in the labor movement in the San Francisco Bay region, and is Co-Director of the Center for Policy Analysis on Trade and Health. Both guests participated in a fact-finding mission to Ghana on the privatization of Ghana's water supply which took place in Spring, 2002. Commentary: PRESIDENT BUSH'S ECONOMIC STIMULUS PROPOSAL AND ITS IMPACT ON PUBLIC HEALTH. Public Health Radio host Marvin Malek analyzes the president's proposed economic stimulus package and evaluates its impact on public health.