The Comics: A Funny Place to Find Serious Public Health Issues?

On a recent trip to visit my in-laws, I was very happy to find that I had time to relax and read the paper in the morning. For me, the joy is found in reading the comics and completing the word search. So you can imagine my surprise when I sat down to read the comics and found that Doonesbury was discussing a very serious public health issue- sexual assault and harassment in the military. Apparently this storyline has been playing itself out in a series that follows Roz (a female soldier who is worried and seeking help for her friend Melissa). Melissa is being reassigned so that a superior officer can "prey" on her.

According to the Veterans Administration (VA) website, "Both women and men can experience sexual harassment or sexual assault during their military service. VA refers to these experiences as military sexual trauma, or MST". Like other types of trauma, MST can negatively impact a person's mental and physical health, even many years later. Every VA facility has a designated MST Coordinator who serves as a contact person for MST-related issues. Here I'll give a shout out to my favorite public health social worker, Micaela Cohen, who is the field and program development coordinator for the national military sexual trauma program at the VA.

Obviously, sexual assault is a serious public health issue, as it can put soldiers and veterans at a higher risk for negative health effects, such as depression. MST can also affect the rate at which health services are utilized. A recent study published in the journal Women's Health Issues reported that, "the under utilization of specialized PTSD services by younger women could be due, in part, to the fact that a significant proportion of PTSD in female veterans is associated with a history of military sexual abuse. Women with a history of military sexual trauma may not feel comfortable either in mixed-gender groups or using services in which treatment is oriented primarily toward combat-related PTSD."

For years, Doonesbury's author- Garry Trudeau, has been taking these types of statistics and important global issues and using them to shape his comic strip. For example, in 2006, he had his character B.D. wounded as he served in Iraq. In a 2007 interview with Military.com about the storyline, Mr. Trudeau stated, "I originally considered having him die in combat, but I concluded that while that might have caused a brief sensation, it would soon be forgotten. In the alternative, by giving B.D. a life-altering wound, I could set in motion a sustained story arc that tracked the arduous recovery and readjustment issues that a survivor might expect to face. "

Although public health practitioners may come across stories and statistics about the health issues and challenges faced by our service members everyday...the general population does not. And even if they do, I'm not sure that they would feel comfortable talking about it. Therefore, I think that inserting public health and social justice issues into the comics is an innovative idea. The comics are a "familiar" section in the newspaper to readers of all ages. We get to know the characters and follow them for years or even decades. The characters can give us a shared and "safe" way to discuss difficult issues. I just hope that as newspapers continue to struggle and more of us are reading our news online...that we don't forget to read the comics! It might not always be a laugh...it might be something even more important.

iPads and other wireless technology: Forget the fun...will they be the next great public health invention?

iPad mania is sweeping the nation! It even made a cameo in my new favorite show, "Modern Family". In a recent episode, all Phil Dunphy wants for his birthday is an iPad. He is excited to use it for web browsing, eBook reading, and video watching. But what if it could also improve his health?
A great article in The Economist this week called, "When your carpet calls your doctor", examines how the convergence of wireless communications, social networking, and medicine will transform health care.

This concept appears quite realistic for several reasons:

• Doctors are already using and comfortable with the technology. The article quotes a forthcoming report by the California Health Care Foundation that found that two-thirds of doctors are already using "smart phones" (a mobile phone with advanced capabilities such as Internet connectivity). Doctors are also used to turning to their computers and/or wireless devices for programs like Epocrates to review treatment information and decision making tools.

• Wireless technology reduces treatment barriers such as the distance and/or availability of the health care provider. One example of the technology being developed is a device which will be able to contact a doctor when his/her elderly patient is about to take a fall in their residence. The article also quotes successful work being done in developing countries such as Rwanda and Peru. This work has expanded to public health programs in the United States, such as Text4baby. This is an educational program of the National Healthy Mothers, Healthy Babies Coalition (HMHB). Women who sign up for the service will receive free text messages each week, timed to their due date or baby's date of birth.

• This technology is aiming to address barriers and facilitators of Behavior Change, not just an increase in knowledge! The focus soley on education to increase knowledge is the downfall of many public health programs. Knowledge alone will not change behavior. However, check out the programs from the company Virgin HealthMiles. They have begun using online social networks, through which co-workers or family members can cheer on or nag patients electronically, in order to encourage exercise or weight loss. The company is beginning to explore how to increase the level of social support and social/family acceptance that patients receive regarding their recommended treatment. Lack of support in these areas can often be a barrier to treatment success.
  

Of course there are still a few things that remain to be seen about the success of these eHealth programs. What are the privacy implications? Are smart phones (or similar wireless technology) widely available to the populations that most need these interventions (e.g., low socioeconomic status, the elderly, rural residents, etc)? What do my readers think?

Personal Responsibility and Health: Who Should Pay For Your Cheeseburgers?

Last year one of my "friends" on Facebook posted a status that infuriated me. It said "Why should I pay for health care for people who can't stop eating cheeseburgers from McDonald's?" I'm never one to downplay the importance of individual health behaviors like diet and exercise. In the three years since I met my husband he has gone from eating "less than one" (his words) serving of fruits/vegetables a day to at least four or five a day. And I'm sure that was the result of my gentle "nudging" because I was concerned for his health. However, this oversimplification that all acute or chronic illnesses are caused by "overweight people eating McDonald's" is incredibly ignorant. We cannot have a discussion about facilitators and barriers to good health outcomes without considering a person's environment, economic status, profession, family, peers, attitudes, beliefs, knowledge, etc. The list goes on.

There was an interesting article in The New York Times this week, No Matter What, We Pay for Others' Bad Habits, that explores this very issue of personal responsibility. The story had legs on Facebook and Twitter, so I wanted to incorporate it into the blog. And because I follow such thoughtful and interesting people online, I thought I'd include one of their quotes to demonstrate my point above (I removed her name in case she isn't interested in being a blog celebrity):

• "The notion of personal responsibility becomes almost a moot point if we don't have an environment that supports our ability to responsibly make "the healthy choice". As the Institute of Medicine says, "It is unreasonable to expect that people will change their behavior easily when so many forces in the social, cultural, and physical environments conspire against such change".
  

Some thoughts:

• Perhaps the hourly worker would like to make it to his healthy/yearly check-up at the doctor. However, because his job doesn't offer sick time since he's part-time, he could be fired for missing work. Therefore, he decides to miss his appointment, flu shot, blood pressure check, etc....because his paycheck is more important to his family.
  

• Perhaps there are a large number of people in a lower socioeconomic bracket that eat McDonald's cheeseburgers (as my Facebook "friend" noted above)...but maybe that's because there are no Whole Foods or Trader Joe's Markets in their neighborhoods. And maybe they don't have a car to drive to one and/or the bus route doesn't pass those stores. And I know that those $1 burgers are a little less expensive than the $10 Rotisserie chicken that Whole Foods sells.

• Perhaps a parent wants their child to walk or ride their bike to school for exercise, but their neighborhood isn't safe. What if there are no side walks?
  

• And what about the impact of genetic and environmental factors in disease? A strong family history of cancer and heart disease cannot always be canceled out by eating vegetables and heading to the gym. And what about those people that are exposed to dangerous chemicals in their jobs. What about those that now suffer due to exposure to asbestos in their jobs before we knew how bad it was? Do they not deserve health care?
  

Again, I'm not downplaying personal responsibility. Patient compliance, healthy eating, and exercise are incredibly important. But let's not forget the complex systems which influence the health of individuals.

And to end with a Facebook "friend's" status that made me less angry: "I mean, seriously, if you're getting that angry cuz a fellow human being can now go to the 'effin doctor, you probably could use a few moments of self reflection..."