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 :)