Public Health Radio

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.freeclinics.us/ and the Vermont Coalition of Clinics for the Uninsured: http://www.vccu.net/ .

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 at http://www.transact.org/ .

Dr. Marvin Malek interviews Dr. Richard Dudley, a founding member of the Commission on Safety and Abuse in Americas Prisons, about the public health aspects of incarceration in the U.S.

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.

Dr. Marvin Malek interviews Dr. Jacqueline Darroch on abortion and unintended pregnancy.

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 .

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. Jim O’Connell 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. Information 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 at http://www.bphc.hrsa.gov/hchirc . 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 .

Elaine Hills interviews Jeff Goodell on the public health hazards associated with the coal industry. 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 sourceand 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 worlds 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 Americas 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 coals 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.

This month's 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.

Four years 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. Dahr 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 website: http://www.dahr.org . 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.

Year 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 reforms. 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 .

This 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.