Bioethics

From a religious standpoint, is modern biotechnology to be interpreted as “playing God” or as collaborating in the on-going work of creation? ~Dr. Gurinder Shahi

The above question expresses an important ongoing bioethical debate. Within many religious traditions, ultra conservatives often see modern biotechnology as playing God. In-vitro fertilization (IVF), genetic engineering, and other medical interventions have been argued to be playing God. Along this line of argumentation, Jehovah’s witnesses do not accept blood transfusions, for example. However, other less conservative individuals of major religious traditions see humans as co-creators. That is, God endowed man with the mental capacity and resources to address new problems in novel ways. Francis Collins, for example, is an evangelical Christian and head of the Human Genome Project who reconciles modern science and Intelligent Design (see Language of God).

In certain cases, the line of what is acceptable to members of various religious traditions becomes hazier. For example, In-vitro fertilization (IVF) with donated oocytes allows infertile women to become pregnant in their sixth decade of life (see Dr. John Jain’s work at USC). I tend to agree with the co-creator camp. However, I feel that certain biotechnological innovations are unethical, as in the above case. What do you think?

Business ethic vs. human ethic

YouTube video Private Medicine is evil? raises a number of criticisms about the private healthcare system in America. Of particular interest to me is the argument expressed in the closing statement: “Profits for human life in my mind is evil.” What I think he means here is not necessarily that people and organizations shouldn’t profit for helping people, but rather that not helping those who cannot afford care is wrong. It’s important to distinguish between his explicit statement here and his larger argument. The narrator’s problems are that 1) large private corporations have been socially irresponsible, and 2) when financial incentives are the driving force of healthcare, glaring disparities often arise.

I tend to agree that universal healthcare is a more socially responsible approach (while some large corporations such as the Bill & Melinda Gates Foundation, have taken seriously their responsibility to give back to society, not all large corporations have been so altruistic) but I believe that present capitalistic values hinder the enactment of such a policy in America and elsewhere. A big concern of mine is the effect of the exportation of American capitalism on foreign cultures and economies—particularly when private approaches are not partnered with public entities that protect the health and economic interests of all those impacted. This is somewhat different from the argument for universal healthcare, as described above, but the underlying skepticism about capitalistic enterprises rings true in the case of providing quality of care in developing countries as well. With western values the way they are today, there is a tension. If we want to move towards a more socially responsible society, business ethics cannot replace the more overarching human ethics.

Healthcare Financing in Texas: Case Study

An article in the NYTimes illustrates part of the problem with healthcare financing in America today. Dee Dee Dodd is a 38 year old woman who lives on a country road in Hays County, Texas. Among the working poor, the Dodd family makes too much money to qualify for Medicaid under stringent Texas laws (if a working parent of two or more makes more than $3696 a year, he or she is ineligible). With between 150-250% of the federal poverty limit, the Dodd family cannot afford private health insurance. Ms. Dodd was diagnosed as a “brittle diabetic” ten years ago when her weight fell to 82 pounds. Years of low access to health care had weakened her and led to preventable side effects like esophageal ulcers. Additionally, repeated episodes of ketoacidosis were life-threatening. In one 18-month period, Ms. Dodd accumulated over $191,000 in unpaid hospital bills for emergency room visits and time spent in the intensive care unit. As a result, Ms. Dodd was classified as a “frequent flier,” or a repeat patient whose disease and expenses could be decreased with more regular medical care. The Seton Family of Hospitals enrolled Ms. Dodd in their charity program, where she now receives free primary care. The use of a $3,200 insulin pump and access to an endocrinologist and home counseling have helped reduce the severity of Ms. Dodd’s ailments. Her health has improved, her medical bills have been cut, and the hospital’s costs have been cut as well. In 18 months, her care cost Seton $104,697—significantly less than the previous period when Ms. Dodd was not a part of Seton’s charity program.

For individuals with chronic conditions, better care not only decreases disease, but may also decrease patient and hospital costs. Seton's charity program is among others that have taken novel approaches to curb hospital costs in Texas. Recognizing the many problems with healthcare financing in America today, states are taking the lead on developing plans that better address health/financial/ethical complexities. One recent example is Massachusetts’ plan to have 99 percent of adults covered by health insurance. With healthcare financing on the state and national agenda, it will be interesting to see how things change within the next decade.

Terrorist incidents: has public awareness increased response preparedness?

Among the man-made disasters, one has received increased attention in the minds of the western world: terrorist incidents. One BBC video clip entitled “The Power of Nightmares,” argues that in the past, politicians offered dreams to the people. As people have lost faith in these ideologies, politicians are seen increasingly as managers of public life rather than as visionaries. Instead of offering dreams, politicians have restored a sort of prominence by promising to protect us from nightmares: Dreadful dangers we do not see or understand… international terrorism with vast networks. The journalist in the clip argues that such threats have been exaggerated and distorted by politicians.

There is a definite need in society to have infrastructures in place for multi-sectoral responses to devastations if and when they occur. The threat of terrorist incidents is a relatively new challenge that theoretically requires a number of the same considerations as other large scale threats (for example: war, natural disasters, and severe weather). Because there is a prospect that terrorist incidents could result in mass casualties or devastation to socioeconomic functioning, such threats do need monitoring, surveillance, and rapid response. Currently, new policy measures and military activities have taken steps towards responding to the threat of terrorism. While such steps are proactive, I have many concerns with the breadth and depth of our approaches. Most importantly, I am of the mind that this should be one of our lesser concerns in terms of potentially devastating threats. While on the agenda, disease outbreaks and natural disasters receive less public attention than terrorism and may in reality pose more of a threat to American citizens.

As is the case for other threats, public awareness is one way to better response capabilities within the population. As a basic example, educating individuals what to do if an earthquake is felt, and what provisions to have within the home have increased earthquake preparedness. But what has been the benefit of widespread public attention to terrorist threats? Politicians’ image is developed as our protectors from terrorism and the media cashes in, but what other (and whose) interests are served? Are we as individuals better off due to the media exposure, for example?

***With tremendous public awareness about terrorism, are we more prepared if something happens, or has a culture of fear pervaded our society? ***

I will close this week’s blog by encouraging you to watch a hilarious 16 second clip entitled “fear of terrorism.” Cheers.

You know the world is going crazy when...

"You know the world is going crazy when the best rapper is a white guy, the best golfer is a black guy, the tallest guy in the NBA is Chinese, the Swiss hold the America's Cup, France is accusing the U.S. of arrogance, Germany doesn't want to go to war, and the three most powerful men in America are named Bush, Dick, and Colon."

- Chris Rock

Technology and quality of life. Are we better or worse off?

I’m going to be all over the place in this blog entry, so try to stay with me…

For starters, I found the following Ancient Chinese Curse quite poignant for several reasons: “May you live in exciting times.” Individually, I feel inclined to a peaceful life—one that is not marked by long hours, competition, and high stress. However, I was born into an era where increasing technologies and globalization have made peace something to look forward to during retirement, rather than integrated into the daily lives of the general western population. We may live during exciting times, but do we live better lives because of it?

Admittedly, technologies have made the lives of individuals within the developed world abundantly more comfortable. However, with increasing access to the world around us, has our quality of life significantly increased? Undoubtedly yes… in some areas. BUT—I still find it incredibly ironic that 1) urbanization has placed so many people in such close proximity, 2) technologies have made it so that if we want to contact some one we have a plethora of resources at our disposal (call, text, e-mail, skype, facebook/myspace message, fax, etc, etc… or meet in person) and 3) we are marked as one of the loneliest cultures in history.

I guess what I’m saying is that I question some of the associations between increasing technologies and their effect on psychosocial behavior & well-being.

Nonetheless, the technological revolution offers considerable promise in the arena of public health. Particularly, gadgets can be used to monitor health status (or track disease maintenance) continually and thus provide a way for preventive medicine to enter into mainstream western medicine. Such breakthroughs offer the most immediate promise to those with chronic disease as well as aging populations. Continual health surveillance means that patients can be managed out of the hospital. When heart rate fluctuates abnormally, or cholesterol increases beyond a given value for example, steps can be taken to address the problem before there is a devastating (and expensive) medical emergency. As technological breakthroughs occur, methods to promote health, prevent disease and even treat disease will continue to change the medical infrastructure and the way that we perceive personal health. Such alterations also promise to change the way we live our lives…

Will the outcomes of such breakthroughs better or worsen our quality of life? Will we become like machines, fine-tuned to be healthy and to continuously compete in the international marketplace? Or can we find a balance—utilizing technologies to better health without being consumed by the impersonal matrix of technological advancement? (Human advancement???)

Will such trends further delineate the world’s rich and poor? There are just so many questions and such heavy baggage that this topic brings to the table. Nonetheless, we cannot avoid such questions because this topic will continue to define the world we live in. We must strive to use technologies—medical, informational, communication, etc.—as a tool, rather than as an end.

Public entities as consumer of high cost innovations

Both pharmaceuticals and technological innovations require high R&D expenditures, both offer novel ways of addressing healthcare concerns, and the patterns of adoption may be compared (although the channels of adoption may be somewhat different). A NYTimes article caused me to consider some of the financial considerations regarding innovations relating to healthcare. This article focuses on novel cancer drugs. While they provide new hope for the treatment of cancer, they do so at a high patient cost and at a high cost to society.

In a lecture with a physician and administrator for Los Angeles County healthcare, I became aware of some ethical concerns associated with these trends. In particular, the high cost of cancer drugs (and novel technologies) not only affects the patient/consumer and his/her insurance, but also the taxpayer. Expensive innovations are not only bought by private organizations, but by public ones as well. As such, issues of distributive justice arise. Should the uninsured have access to novel technologies even when this means less resources for other patients, or other hospital departments? Who should decide how the taxpayers money is spent on various innovations relating to healthcare? When the efficacy of these innovations is limited, but beneficial nonetheless, how does this effect what should be considered the appropriate degree of utilization by public entities?

For arguments sake: what if there was a new vaccine that could cure diabetes, but cost $100,000 per shot. Who should have access to the vaccine that can’t pay for it on his or her own? If the government can buy a certain amount, what is the ethical distribution? What if the vaccine is known to be 20% effective; how does that alter the utilization by publicly-funded hospitals?

As the cost of technological innovations increases, can public entities afford to be a major consumer to the detriment of other types of purchases?

Renewable Energy: Argument for Rapid Transition

Digging into the topic of renewable energy last week, I became acutely aware how big an issue our current energy usage is today. In Energy Autonomy (2007), Dr. Hermann Scheer argues that our current reliance on traditional energies has resulted in (or augmented) what he calls the “seven energy-determined world crises” (the global climate crisis, the exhaustion and dependence crisis, the poverty crisis in the developing countries, the nuclear crisis, the water crisis, the farming crisis, and the health crisis). I believe that an honest consideration of Dr. Scheer’s argument brings about three potential responses.

First: Dr. Scheer is wrong and therefore these problems would not be alleviated if we altered our energy usage. Second: Dr. Scheer is right and we should therefore respond rapidly with more responsible energy usage. Third: There’s nothing that I can do (regardless of whether Dr. Scheer is right or wrong).

Individual research the past two weeks has brought me to this place… The preponderance of data suggests that Dr. Scheer is right in many of his claims. Therefore, as a citizen of the global community, I feel that it is my responsibility to work and advocate for a faster transition away from traditional energies and towards renewables.

In our discussion last week, we addressed a number of blockades to shifting the energy usage paradigm. Indeed, there’s a lot standing in the way. But if we take these crises seriously, I don’t think the third response (above) is an ethical option because of the potential severity for future generations.

The simple fact that the sun and it’s derivates supply more than 15,000 times our current usage in nuclear and fossil energies… coupled with our increasing scientific know-how/ engineering expertise… gives significant hope to the situation. The biggest hurdle is will-power.

The question – I believe – at the heart of this debate is about us as humans. Are we, as a society, inherently short-sighted and selfish or do we value the lives of those who are to come after us enough to make sacrifices now?

Mental Health: Penis Snatching & Terrorism

With last week’s topic being “Mind, Behavior, and Global Health,” I recalled an interesting article posted by Professor Shahi entitled “Koro: A Natural History of Penis Panics” that discusses Koro – the belief in retracting genitals or genital theft. This article sheds light on how powerful the mind can be in the context of human perception of health. I mean, think about it: if many men have believed erroneously that their penises have retracted into their bodies or been stolen, one is caused to question the limit of the human imagination in constructing medical maladies or threats.

Additionally, this article points out that social influences may be strong shapers of individual beliefs, stating: “…we are much more likely to believe what our neighbours believe than we would like to admit.” In the context of mental health, this raises some interesting questions about community influences. Mental health services are mostly designed to meet individual needs – particularly those with diagnosable mental health disorders. What benefit could community approaches to mental health have in bolstering general well-being?

***If there are outbreaks of seemingly ridiculous social beliefs like penis snatching, what happens when legitimate social beliefs arise?***

To be honest, I am more afraid of the widespread social panic associated with terrorism than I am with terrorism itself. What happens if our worst fears are realized and there is a substantial terrorist attack on American soil? We may have the medical infrastructure to address the acute care of serious injuries that would result, but do we have the mental health infrastructure to address the community panic that would also result? Is it unreasonable to consider population approaches to panics and such outbreaks of a mental nature?

YouTube Obesity

One young man is documenting his struggles with obesity through a series of youtube videos entitled "Losing It."This on-line video journal provides strong support to the implication that there may be a correlation between video game popularity and obesity. Themes "Mr. Losing It" expresses in the video journals are of overcoming stress, difficulty maintaining a healthy diet, and of a severe addiction to video games. One of his videos made me laugh, so I thought I’d share it with you all. These addictive lifestyle attributes are on the rise in America.

The Sahel region in Africa is experiencing a crisis of malnutrition of a completely different type. With an average of eight children per family and food/economic stability a concern, there is a struggle to provide enough food & nutrients for child survival.

These two stories illustrate the vast discrepancies in malnutrition experienced in the world today. I don't seriously mean it when I say this, but an interesting obesity intervention would be to provide obese Americans between the ages of 18 and 25 (like Mr. Losing It) the opportunity to visit regions such as the Sahel for a week... How I'd love to see the youtube video journals in response to such a trip :-)

Oxfam: Micro-lending... fight poverty with just a click!!!

Go to the website. Choose USC as your school. Click the "click to donate" button twice a day and get $.25 given to micro-lending in the fight against poverty each time you click.

http://www.povertyfighters.com/

-You can only click twice a day
-You don't donate any money, other companies do when we click
-Make sure and set USC as your school
-Spread the word to friends
-The click drive ends March 30th, make sure and click twice a day until then!

Native and contemporary American values: considerations on obesity

Personally, I find the Western trend towards diseases of excess disgusting. The obesity epidemic is powerful social commentary in and of itself... people are literally eating themselves to death. In a way, I think global capitalism in the age of technology fosters obesity. People can work in a cubicle all day to make money that can be spent with the click of a mouse to purchase foods, travel, entertainment, etc. Whereas physical activity was once a necessary component in survival (to obtain foodstuffs, among other purposes), for many people it has become a purely recreational endeavor.

This week, I was assigned to leading a discussion following a screening of Dances with Wolves in which Native American culture is glorified and the U.S. value system is undermined. The film makes powerful social commentary that caused me to re-evaluate contemporary American values. In my research, I came across a fascinating article by Native American Rt. Rev. Steven Charleston entitled: “From Medicine Man to Marx: The Coming Shift in Native Theology.” Chaleston suggests that the Native peoples are a colonized people whose worldviews contrasted with that of the foreign culture and colonizing power. He argues that Native Americans in conglomeration with other minority voices should cry out against technological consumerism (prevailing value system/ worldview). He argues for a Native alternative called ‘commonality,’ with six principles that form the basis of the Native People’s Liberation theology.

A personal consideration of this ‘alternative’ has called into question the global capitalism and technological consumerism that has lead to rising obesity. I kind of chuckled when thinking to myself what the buffalo hunting scene in DWW would look like if all the Sioux tribes-people had the sort of obesity that distinguishes a number of Native American tribes today. Perhaps the commentaries provided in DWW and by Charleston provide some insight for a civilization with values different from those held by contemporary popular culture that would promote physical activity and healthy lifestyles.

…perhaps idealistic- but an interesting consideration nonetheless J

Obesity study (no self-reflection)

Opening the Daily Trojan today, I was struck by an article entitled "Obesity clinic targets Latinos." Most of the students in USC's MPH program have probably heard about this new intervention, as the department e-mailed MPH students about a paid internship available in this clinic. The lab's first study involves the Strength and Nutrition Outcome for Latino Adolescents (SANO-LA), which targets at-risk individuals to decrease added sugar and increase dietary fiber. The study features a nutritional (meets 1x/wk for nutritional lessons and exercises), combination (meets 2x/wk & in addition to the nutritional arm undergoes strength training exercises), and control (receives no treatment) group. After testing Latino adolescents, the same study will be conducted on black youths later this year. Eventually, researchers would like to conduct the study on Caucasian and Asian populations. With the obesity epidemic affecting more and more of the American population, this is the kind of study thatI believe offers hope for providing the kinds of insights necessary to cater health promotion intervention strategies to the particular needs of specific populations.

Epidemics and Nutshells...

Reading my classmate Robyn Eakle's PM565 week three blog (http://robyneaklesblog.blogspot.com/), I was caught by a certain passage she wrote concerning what her yoga instructor said:

"Isn't it hilarious to think about the fact that most of the time we are all walking around with this protective armour on and so concerned about keeping it together, that we don't realize that we are all doing that same thing. What would happen if we tried the opposite, and cracked that shell open, realized that we all are coming from different experiences and often the same feelings. What would happen if we were all open to one another?"

I was inclined to comment on her blog regarding this passage, but would like to further explore the line of thinking. I'm the kind of guy who tries to smile at and make small talk with strangers on the street. In every new relationship and conversation, I've learned that each person and each interaction teaches me something new. However, as much as I believe in the sentiments presented by Robyn's yoga instructor, it seems to me as if the fear of epidemics and bioterrism has caused people to hide even deeper in their 'protective armor' rather than to ‘crack their shells open.’

Understandably… increasing frequency of interpersonal contact and exposure to individuals from different communities fosters the spread of diseases. In addition to diseases, strangers may wield weapons, and ill intent. I’m not arguing that personal protection from harm and disease is the primary reason why people hide in their shells when in public. Indeed, many people would claim that they’re busy (and would rather listen to their IPod or read the newspaper) or question the benefits of chatting to strangers.

Rather, I’m merely pointing out a trend - that the fear of epidemics and bioterrism harbors a sense of suspicion and protection from those around you that are strangers. I believe the impersonal nature of public transportation and locations will only become more impersonal as time goes on. As an example, students at the University of Michigan are currently assessing whether masks protect against bird flu (http://www.nytimes.com/reuters/news/news-birdflu-students.html?_r=1&oref=slogin). Imagine going into a subway station where everyone around you is wearing a gas mask. Are you more likely to ‘crack out of your shell’ and start up a friendly conversation, or hide behind your ‘protective armour?’

Meanderings about Globalization (personal reflection)

As a young idealist, I have a number of qualms with current trends in globalization. Particularly, I feel at odds with the United State’s approach to international assistance. As stated by USAID, the federal government agency responsible for most ‘non-military foreign aid’ (I won’t delve into the question of whether military foreign aid truly constitutes effective ‘aid’), “Our work supports long-term and equitable economic growth and advances U.S. foreign policy objectives by supporting: economic growth, agriculture and trade; global health; and, democracy, conflict prevention and humanitarian assistance” (http://www.usaid.gov/about_usaid). On the surface, supporting economic growth as a means of foreign aid makes sense considering that economic freedom is associated with better health outcomes. However, after evaluating the situation more deeply I can’t help but feel slightly disgusted that the purpose of USAID’s strategy is to “help American business succeed in foreign markets and help developing countries create conditions for investment and trade” (http://www.globalizationandhealth.com/content/1/1/6). I think to myself: there are millions of people dying and suffering needlessly every year and America reason for helping them is to establish flourishing markets for import and export. Logically, the approach makes sense: if people aren’t healthy, they can’t work and if people don’t work they won’t have the means to buy and sell. But I would like to think that humans have some intrinsic value that is being ignored in this equation. Dr. Shahi’s response to this line of questioning was comforting. He argued that true leaders can use economic speak but their primary motivation is public health. Indeed, there is a tie between economic development and human development. Admittedly, I think I’m just sorrowful that this sort of speak needs to be implemented at all when the topic is mortality and morbidity. I guess I just wish this world wasn’t so financially driven…

Summary: Globalization Films (no personal reflection)

Positive and negative implications of globalization are expressed in Johan Norberg’s video “Globalization is Good”
and in the University of Hawaii’s “Globalization and the Politics of Public Health.” Norberg travels to Taiwan, Vietnam, and Kenya in order to show the positive effects of globalization on the represented peoples and economies (ex: Taiwan and Vietnam) as well as how restrictions on open trade may be detrimental to peoples and economies (ex: Kenya). Norberg argues that the anti-globalization movement is ignorant and dangerously wrong. Rather than lobbying against globalization, Norberg advocates that we lobby for trade reform. The University of Hawaii’s film is a powerful critique towards Norberg’s argument. Looking at Pacific Islanders and Marshall Islanders, the film shows how globalization has tended to privilege the well organized and large populations over and against those who are less well organized and smaller. After watching the two films, I asked myself whether globalization tends to be beneficial for all peoples, or exploitive of peoples and environments.

Perspectives Summary (no personal reflection)

Analyses on the impact of globalization on health in different parts of the world may help develop insights into the complex processes of globalization. In Thailand, globalization trends have had direct health effects as well as indirect effects. Direct health effects include unequal access to medical care by different social groups, increasing problems of environmental pollution, rising new/ resurgence of old infections, and unhealthy lifestyles. These direct effects have been associated with an economic crisis in Asia, which has led to a rise in suicides, malnutrition, abandoned children, low birth weight, and a rise in deaths from preventable diseases (Perspectives: Globalization and Health Viewed from Three Parts of the World (2001). “Some health implications of globalization in Thailand.” Bulletin of the World Health Organization, 79 (9), 889-890). The United Kingdom, which was once seen as the model system, was became viewed as inefficient with increasing technologies. The movement from discrete national to international healthcare perspectives has elicited the UK to set globalization and health as priority areas for research and policy. (Perspectives: Globalization and Health Viewed from Three Parts of the World (2001). “Some health implications of globalization in the United Kingdom.” Bulletin of the World Health Organization, 79 (9), 889-890). In Kerala, India, the forces of globalization caused a paradigm shift to a capitalist model. Prior to this change, there was low wealth but relatively high average health statuses. Globalization has resulted in increasing inequality in Kerala, challenging the Kerala model of low cost health care (Perspectives: Globalization and Health Viewed from Three Parts of the World (2001). “Some health implications of globalization in Kerala, India.” Bulletin of the World Health Organization, 79 (9), 889-890). These particular case studies shed light on the complex impact globalization may have on particular regions of the world and emphasize how economic development affects health status through altered access to healthcare.

Order of the Torch bio

Along with father Dr. Michael F. Press (USC Professor of Pathology and Harold E. Lee Chair in Cancer Research) and brother Oliver A. Press (USC Alumnus ’02, current medical student at USC Keck School of Medicine), David J. Press (USC undergraduate senior with a major in Health Promotion and a minor Religious Studies) is a proud member of the Trojan Family. David has been involved with Alpha Gamma Omega, the Christ-centered fraternity, since his first semester at USC. Serving as Treasurer, David assisted AGO in transitioning into their first house on Fraternity Row. As President of the Invisible Children Movement at USC, David flew to Washington D.C. to lobby California’s congressmen to alleviate the dire situation for the children of Northern Uganda. He has volunteered at the USC University Hospital, St. John’s Free Clinic and with the Hurricane Katrina relief effort. David has also served as President of the USC Biotechnology Club and Treasurer of Mortar Board, a national senior honors society. Other honors include: Omicron Delta Kappa (leadership honors society), Gamma Sigma Alpha (Greek honors society), Theta Alpha Kappa (religious studies honors society), USC Alumni Club scholarship recipient, and USC Renaissance Scholar candidate. David is currently a combined bachelor's and master's (Public Health) student at USC's Keck School of Medicine.
Since the summer of 2002, David has been a member of the Manhattan Beach Kyokushin Karate Dojo where he has been dedicated to cultivating his mind, body, and spirit and aspires to achieve his black belt. David is grateful to Sensei Patrick Fard for encouraging David to find a balance in all areas of life. David’s professional interests are as diverse as his extracurricular involvement. Under the supervision of Dr. Leslie Bernstein of the USC Department of Preventive Medicine, David has conducted epidemiological research assessing the association between reproductive surgeries and breast cancer risk in a large population of US women. Possible fields of post-graduate study for David include medicine, epidemiology, and public health. David feels honored to be among the twelve exceptional Order of the Torch members. Looking back on his time at USC, David feels blessed to have experienced such diverse opportunities and met such inspirational people.

PM565_Week 1

As a concept, I find global health immensely appealing. To promote health and well-being at the international level is an enterprise of profound proportions. ‘For all people to be free from the captivity of disease, poverty, and hunger…’ ‘For all people to be fully experiencing physical fitness, mental acuity, social fulfillment and spiritual realization…’ These are the sort of mission statements that fill aspiring young health practitioners with a sense of hope and purpose. I fit into this category.

However… as a construct, I find global health immeasurably overwhelming. Breaking health promotion into its constituents, bolstered quality of life and prolonged life expectancy are hard entities to tackle. Thinking as a data analyst and future epidemiologist, I tend to break large constructs into smaller “boxes.” The countries, nations, states, cities, populations, cultures, schools, and individuals are medium-sized boxes that make up the world. The physical, mental, spiritual, social, and environmental boxes each fit into those medium-sized boxes. Looking at it altogether while considering paradigms of the past, present and future, my mind absolutely spins. The infinite number of boxes and permutations therein comprise the one large box labeled “global health.” Recognizing the puzzles represented, I question whether I have it in me to consider the whole jumble at once.

These two conflicting perspectives found expression during Hans Rosling’s portrayal of epidemiological data. Rosling saw the need to communicate data which led him to generate a series of animated data collections that illustrate various aspects of health and wealth. Watching the animated datasets, I felt on the one hand liberated by the sense of knowledge of concrete trends in global health. Particularly, the animated graph of fertility rate versus life expectancy since 1962 illustrated the shift towards long life in small family throughout the world in a way that brought this trend to life. The 'boxes' were somehow opened and their contents presented clearly in relation to the other 'boxes.' On the other hand, I felt overwhelmed. Beyond the recognition of what Rosling points out as the locked nature of various datasets from widespread dissemination, I began pondering the nature of these seemingly larger than life issues within the big global health 'box.' Looking back on the video and preparing myself for the road ahead, the question looms in my head: “well what can we do about it?”

So, I enter into PM565: Emerging Trends in Global Health Leadership at USC (taught by Professor Gurinder Shahi) with big dreams tempered by realistic expectations. I'm ready to tear the wrapping apart :)