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 #59 (December 2005) THE DETRITUS OF WAR: LAND MINES, UNEXPLODED ORDNANCE, AND THEIR VICTIMS [MP3] This week's show is a documentary on land mines and their victims. Produced by Public Health Radio. Dr. Marvin Malek explores the public health impact of land mines and unexploded ordnance. He interviews survivors of land mine explosions, doctors and other health personnel who care for them, public health activists, a representative of the U.S. government, and individuals who clear lands of buried mines.

Program #58 (November 2005) DISASTERS AND PUBLIC HEALTH, PART 2 ~ PREPARING FOR NATURAL DISASTERS [MP3] Dr. Marvin Malek interviews Jane Bullock, research scientist and an Adjunct Professor at the Institute of Crises, Disaster and Risk Management at George Washington University. Bullock was Chief of Staff to James Lee Witt, the Director of the Federal Emergency Management Agency under President Clinton. For 22 years, she worked in nearly all of FEMA’s principal disaster programs and served as an Agency spokesperson representing FEMA. She is the co-author (with George Haddow) of Introduction to Emergency Management and Introduction to Homeland Security.

Program #57 (October 2005) DISASTERS AND PUBLIC HEALTH, PART 1 ~ CAUSES: HOW NATURAL ARE "NATURAL DISASTERS"? [MP3] The public health significance of natural disasters became especially clear with Hurricane Katrina in September, 2005: Several hundred people died, thousands developed intestinal infections due to unsafe water supplies and sewage contamination, many suffered from dehydration and exposure after they became homeless, ill individuals lost access to pharmacies for critical medications, and hundreds of thousands of ill and injured individuals lost access to medical care. And then there are frequent mental health consequences---flashbacks, depression, and anxiety-the syndrome known as Post-Traumatic Stress Disorder. So the public health impacts of what are called natural disasters are numerous. In large disasters in any country, and in even much smaller disasters in the poorer countries, these adverse consequences on public health are quite significant. Show 57 is the first in a two-part series looking at disasters. Show 57 evaluates the question: How natural are "natural disasters". Brenda Ekwurzel and Doug Boucher join us to look at the human contributions to these "acts of nature". We'll look at the impacts of global warming, wetlands destruction, coastal over-development, and deforestation on the incidence and severity of natural disasters, especially floods, droughts, and hurricanes. Brenda Ekwurzel, PhD is a geoscientist with expertise and numerous publications in the areas of oceanography, hydrology, and climate science. She currently leads the climate science team at the Union of Concerned Scientists. Doug Boucher, PhD is an Associate Professor of Biology at Hood College in Maryland. His areas of specialty and research effort include Plant and Forest Ecology and Natural Resources Management. For listeners seeking more information on the human causes of natural disasters, listeners are directed to the website of the Union of Concerned Scientists, http://www.ucsusa.org , from which many useful links are available.

Program #56 (September 2005, Part 2) [MP3] and Program #55 (August 2005, Part 1) [MP3]. AN IN-DEPTH LOOK AT MODERN AGRICULTURE AND US GOVERNMENT AGRICULTURAL POLICY: IMPACTS IN THE US AND ABROAD. Frances Moore Lappe joins us to discuss her recent book, Hope's Edge. In Hope's Edge, Frances and her daughter, Anna Lappe, travel to a dozen nations in both the wealthy regions of the world as well as the poor countries of the Global South. From the Landless Peasant Movement in Brazil to Navdanya in the Punjab region of India, Lappe and her readers visit farmers, reformers, and civic activists who demonstrate alternatives to chemically-dependent agriculture. Each movement posits a model for development that promote food security using agricultural techniques which are healthy for farmers, the neighboring community, and those who end up consuming the harvest, and are sustainable to the land and the environment downstream. Show 55 focuses on the Landless Workers Movement in Brazil, the implementation of food security as a citywide priority in Belo Horizonte, Brazil, and the effort in the Punjab of India to improve both the economic condition of farmers in the Punjab and the health of the soil by returning to sustainable agricultural techniques. The second part of the show looks at agricultural policies in the developed countries, especially agricultural subsidy programs, and how they could be redirected to improve both environmental and public health. Show 56 focuses on the Greenway Movement in Kenya and its implications on nutrition, food security and community development. We also contrast the corporate model of globalization with a community empowerment model and its impact on improving the environment, food security and community health. Frances Moore Lappe has spent over 30 years exploring agriculture and hunger, and her work continues to influence the international debate on the root causes of hunger and poverty. Ms. Lappe co-founded the Institute for Food and Development Policy, which works on the causes and prevention of hunger and the Center for Living Democracy, which explores the relationship between democracy, power, and development. She currently works at the Small Planet Institute, which she also co-founded. Ms. Lappe's books have been used in university courses in more than 50 countries, and most-including her recent work, Hope's Edge-are available at the website of the Small Planet Institute, http://www.smallplanetinstitute.org. The website of the Institute for Food and Development Policy http://www.foodfirst.org also contains a great deal of information on the topic.

Program #54 (July 2005) "REVISITING CANADA: THE QUEBEC SUPREME COURT DECISION, AND IMPLEMENTING THE ROMANOW REPORT [MP3]."  Similar to all the other 25 developed nations of Europe, the Far East, and Australia---Canada provides health insurance to its entire population, while spending far less than the United States. In Canada, as in most other developed countries, private health insurance companies are not involved in providing health insurance coverage for most medical services. Instead, the government provides health insurance for all the citizens of Canada. On the other hand most all hospitals and doctors' offices are independent of the government-they are nearly all in the private sector. Furthermore, Canada leads the United States in every major category of health outcome, including infant mortality, maternal mortality, and life expectancy at every age it's measured at for both men and women. But Canadian health system has not been without problems. During the 1990s, the federal government of Canada cut back its funding support of the provinces' health departments, and this gradually led to cuts in capital funding, and delays in access to several types of elective surgery. In addition, despite the fact that the Canadian government negotiates far lower prescription drug prices than we pay in the US, the increasing cost of medicine has also caused financial difficulty for many Canadians. Over the 18 months since Public Health Radio last explored health care in Canada, there have been some important developments, most significantly the effort to implement the recommendations of the Romanow Commission. Especially important will be an infusion of an additional $41B to the system over the next 10 years. The other major development is a decision of the Canadian Supreme Court which ruled that health care in the province of Quebec is so constrained that the ban on private health insurance in the province should be lifted. Two guests join us for this interview: Pat and Hugh Armstrong, a husband and wife team of health care analysts. Pat Armstrong is an expert on health policy in Canada. She has served as Chair of the Department of Sociology at York University and Director of the School of Canadian Studies at Carleton University. Hugh Armstrong is a Professor in the School of Social Work and in the Institute of Political Economy at Carleton University. The Armstrongs have co-authored several books on health care in Canada, which are detailed in the Public Health Radio website, publichealthradio.org. A particular useful book for those of us in the US is a book they authored, called Universal Health Care: What the United States Can Learn from the Canadian Experience. The book is available through the New Press in NYC. Useful websites for listeners wishing to learn more about health care in Canada are the website of the Canadian Health Coalition www.healthcoalition.ca. Another useful resource is the website of the Canadian Health Services Research Foundation: www.chsrf.ca. The CHSRF website contains a great deal of data on health care in Canada, much of which can serve to refute the many myths held by Americans about the state of health care in Canada.

Program #53 (June 2005) "INJURY ANALYSIS AND PREVENTION [MP3]."  INJURY AS A PUBLIC HEALTH PROBLEM: SUCCESSES IN REDUCING THE NUMBER OF INJURIES IN THE UNITED STATES Fred Rivara, MD MPH joins us to discuss the field of injury analysis and prevention. Injuries are the leading cause of death and disability for children and young adults ranging from ages 1 through 44 years of age. Despite this, public health techniques have been applied to the analysis and prevention of injuries for only a few decades. The field is broad and complex due to the wide variety of types of injuries that can occur: Injury researchers may evaluate burns and crush injuries occurring at the workplace, a hip fracture suffered at home by an elderly woman or a head injury occurring when a child is struck by an automobile as she darts into the street chasing a ball that has bounced into the street. For many years, such events were called "accidents". Applying the term "accident" to injuries reinforced the view that injuries were random events that can not be analyzed or prevented. Over the last few decades, however, a cadre of public health researchers and activists have turned their attention to the problem of injuries and have achieved some notable successes, reducing the number and severity of injuries in the transportation system, in the workplace, in playgrounds, and reducing the number of head injuries suffered by children. Show #53 looks at some of the major types of injuries, and approaches that have been taken to prevent these injuries, as well as research findings on the effectiveness of various prevention strategies. Fred Rivara, MD MPH was the director of the Harborview Injury Prevention and Research Center at the University of Washington in Seattle from 1987 to the year 2000, and has published dozens of articles and books on the problem of injuries, with a special focus on injuries to children. For the last 10 years, Dr. Rivara has served as the Director of the Division of General Pediatrics at the University of Washington's School of Medicine. For listeners seeking more information on the topic of injury prevention, the website of the Centers for Disease Control and Prevention has data and prevention fact sheets on many types of injuries, and useful links to other websites. The website of the Centers for Disease Control and Prevention is http://www.cdc.gov . The National Safe Kids Campaign is active in the area of childhood injury. Their web address is http://www.safekids.org . The website of the American Academy of Pediatrics, http://www.aap.org, has a wealth of useful information on childhood injury prevention, including a particularly effective presentation on how to keep children safe during travel in motor vehicles, highlighting the types of car seats appropriate for children of different ages. EDITORIAL STATEMENT: WHAT TOPICS TO ADDRESS ON PUBLIC HEALTH RADIO The issue of what to cover on Public Health Radio is something we grapple with every month. On a near daily basis, we review suggestions from listeners, news sources ranging from a number of medical and public health journals, reports from the World Health Organization and Centers for Disease Control and Prevention, as well as regular news media outlets. As one might guess, this leads to thousands of items to choose from. On this radio editorial, Marvin Malek discusses the topic areas we cover on public health radio, and the rationale behind these decisions. Marvin Malek, MD MPH is the host and co-producer of Public Health Radio.

Program #52 (May 2005) "PUBLIC HEALTH IN INDONESIA [MP3]."  IN THE WAKE OF THE TSUNAMI: EXPERIENCES OF AN AMERICAN DOCTOR PROVIDING MEDICAL RELIEF WORK IN ACEH, INDONESIA Despite having the 4th largest population in the world-- and abundant natural resources-the island nation of Indonesia is largely neglected by the media in the US. The preponderance of Indonesia's population is poor, and has great unmet health needs. Aceh was one of the poorer provinces of Indonesia even before December 26th last year. But the double hit of a powerful earthquake followed immediately by a tidal wave devastated the already poor region. Show #52 discusses public health, and health care in Indonesia. Dr. Craig discusses the impacts of the recent natural disaster, and the medical relief work he was involved in on his recent trip to Indonesia. Sandy Craig, MD, just back from his work at a mobile clinic in the Aceh area on the island of Sumatra, Indonesia. Dr. Craig is a family practitioner who took a temporary leave from his medical practice in a rural clinic in Plainfield, Vermont to work as a medical doctor in the region of Aceh that lay right in the path of the natural disasters. Doubly trained in Family Practice and Emergency Medicine, and fluent in the Indonesian language, Dr. Craig was in a unique position to directly assist the people in Aceh with their effort to recover from the natural disasters. Dr. Craig's relief mission was organized by the International Medical Corps-web address http://www.imcworldwide.org .

Program #51 (April 2005) "PUBLIC HEALTH AND FACTORY FARMS [MP3]." PUBLIC HEALTH IMPACTS OF FACTORY FARMS. Factory farming is the popular terminology that refers to concentrated animal feeding operations ("CAFOs"). CAFOs use industrial techniques of mass production are to raise and harvest animals for mass markets across the country. In these operations, thousands of animals spend their entire lives confined to a small space in massive indoor feeding facilities. Unfortunately, there are many adverse consequences of this type of agriculture on the environment, the animals themselves, and the public health for both consumers and communities adjacent to these operations. And there are even impacts on medical care in terms of trends in asthma, and in the growing problem of antibiotic resistance among bacteria that cause common lung and skin infections. Dave Wallinga and Karen Hudson describe these facilities, the adverse impacts they cause, and the efforts of communities, government, and consumers to limit the harm that can accompany these operations. Karen Hudson is a Consultant for the GRACE Factory Farm Campaign . She lives on a fifth generation family farm in Central Illinois and is President of F.A.R.M. a grassroots organization in Illinois that provides research and technical assistance to communities impacted by agricultural techniques that are a threat to public health. David B. Wallinga, MD MPH is a medical doctor and Senior Scientist at the Minnesota- based Institute for Agriculture and Trade Policy http://www.iatp.org . There, he is Project Director for a major effort exploring the relationship between agricultural antibiotic use and the growing problem of antibiotic resistance in medicine. He has served as a consultant to the World Bank and the World Health Organization, and has authored several articles and books that evaluate the impacts of pesticides and other environmental toxins on child development. The web address of the GRACE Factory Farm Project is http://www.factoryfarm.org . The Institute for Agriculture and Trade Policy can be accessed at http://www.iatp.org . Both websites have many useful links on the issue.

Program #50 (March 2005) "INFECTIOUS DISEASE UPDATES: ANTIOBIOTIC RESISTANCE / AVIAN INFLUENZA [MP3]." INFECTIOUS DISEASE UPDATE: PART 1: THE SPREAD AND SIGNIFICANCE OF HIGHLY ANTIBIOTIC RESISTANT BACTERIA Before World War II, the predominant strategy for treating serious infections was to cut away infected tissue, amputate infected limbs, provide fluids, and administer aspirin to control high fever. Then during the second world war, for the first time in history, medicines became available which could effectively treat many bacterial infections. The sulfa drugs and penicillin during the 1940s and 50s represented some of the most important advances in the history of medicine. But barely had these antibiotics come into widespread use when reports came out of bacterial strains that were able to grow despite the administration of these antibiotics. And now, 60 years into the antibiotic era, the problem of antibiotic resistance among bacteria has become increasingly widespread. The problem is concentrated in hospitals where extremely ill individuals have diminished resistance to infection, and the widespread use of antibiotics exerts selection pressure promoting the rapid evolution of resistant bacteria. A few bacterial strains have been identified that are resistant to virtually every available antibiotic. One example is a Staph aureus strain that is resistant to methicillin and most other available antibiotics. But just in the last few years we have begun to see strains of resistant bacteria even outside of hospitals. Dan Jernigan, MD MPH, joins us to discuss the problem of antibiotic-resistant bacteria. Dr. Jernigan is the Chief of the Epidemiology Section at the National Center for Infectious Diseases at the CDC in Atlanta. Antibiotic resistant bacteria has been the focus of his research at the CDC and elsewhere during his career. The website of the Centers for Disease Control and Prevention contains a great deal of information on the problem of highly antibiotic-resistant bacteria. The web address is http://www.cdc.gov INFECTIOUS DISEASE UPDATE, PART 2: AVIAN INFLUENZA: IS A MAJOR EPIDEMIC INEVITABLE? people who have not been hospitalized. Then later in the show, Niranjan Bhat is joining us to discuss Avian influenza, aggressive viruses that have decimated domestic chickens in Asia, and have demonstrated the ability to also cause serious disease in exposed people. Over the course of human history, influenza has been one of the most common and most deadly of all the infectious diseases. Just as human populations begin to develop resistance to the circulating influenza strains, new strains predictably develop to which few people are immune. In some cases, such break-outs of new and highly resistant influenza strains have led to worldwide catastrophes, such as the epidemic that killed over 20M people just after World War I. Influenza viruses are quite capable of exchanging genetic material with related viruses, and strains of influenza which primarily affect animals are an important source of genes that may lead to increased virulence. Over the last decade strains of Avian influenza have decimated millions of chickens and other domesticated birds in eastern Asia. And now scores of humans exposed to these viruses have developed serious infection, and many of these infected individuals have died. Many epidemiologists and infectious disease specialists view a major human epidemic of Avian influenza to be a virtually certainty, while others have questioned such a prediction. Joining to discuss Avian influenza is Niranjan Bhat, MD MPH. Dr. Bhat is a pediatrician and epidemiologist currently serving as an officer in the Epidemic Intelligence Service at the Centers for Disease Control and Prevention in Atlanta,Georgia. The study of influenza has been a major focus of Dr. Bhat's research. The CDC's website also contains much useful information on Avian influenza. The web address is http://www.cdc.gov.

Program #49 (February 2005) "HEALTH CARE AND BANKRUPTCY [MP3]."  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.

Program #48 (January 2005) "WORLDWIDE RESPONSE TO THE TSUNAMI DISASTER: HOW IT COMPARES TO THE BATTLE AGAINST THE HIV PANDEMIC AND OTHER HEALTH CRISES IN THE GLOBAL SOUTH [MP3]."    On December 26, 2004, a powerful earthquake occurred off the Indonesian coast. The earthquake led to a tidal wave which spread rapidly from western Indonesia and Thailand, then the coast of India, Sri Lanka, and finally eastern Africa, and over 250,000 lives were lost within just a few hours. Over the next few weeks, people across the globe—both rich and poor, even from countries quite remote from the impacted areas—opened their hearts and their pocketbooks to provide food, water, medicine and funds for redevelopment. But during the four weeks after the Tsunami struck, 300,000 people died of HIV infection, and about 180,000 deaths occurred from both malaria and tuberculosis. Yet the generosity shown toward those who are suffering and dying from those illnesses is minimal compared to what was seen after the tsunami disaster. On Show #48, Paul Zeitz and Nils Daulaire analyze the international response to the tsunami disaster, and also to these other public health emergencies. During the show, Drs. Daulaire and Zeitz evaluate the impact of the large debt burden on health systems in the poor countries of the Global South. We also evaluate progress made during 2004 in responding to the HIV epidemic. Nils Daulaire, MD MPH is president and CEO of the Global Health Council, an international membership alliance dedicated to advancing policies that improve health around the world. Before assuming leadership of the Council, Dr. Daulaire served as Senior International Health Advisor at the U.S. Agency for International Development. In that capacity, he represented the U.S. at five World Health Organization annual assemblies, and worked in several countries across the global south, including Nepal, Mali, Bangladesh and Haiti. Dr. Daulaire has special expertise in the area of child health. Paul Zeitz, MD MPH is a medical doctor who has worked for over a decade in Africa with the UN AIDS Initiative, the CDC, and the WHO, He is a co-founder and Exec Dir of the Glabal Aids alliance, a coalition of civic groups founded in 2001 to accelerate the slow pace of world response to the HIV pandemic. The website of the Global AIDS Alliance is located at http://www.globalaidsalliance.org. The webaddress of the Global Health Council is http://www.globalhealth.org., and the website of Jubilee USA Network, a coalition of US organizations working for debt forgiveness, is http://www.jubileeusa.org