A core aim of public health is to care for the most vulnerable members of our society—the marginalized and the dispossessed. At this festive season, when friends and family gather together, and “abundance rejoices,” it seems to me especially important that we focus on these vulnerable groups—people who find themselves excluded from the resources and community ties that generate health. For this reason, we will run a “trilogy” of Dean’s Notes on the conditions that create this marginalization, starting this week with homelessness. The goal is to inspire reflection this holiday season on the vulnerable populations whose challenges are a central concern of public health.
A Spanish flu pandemic infected approximately one-third of the global population in 1918. In the United States alone, about 675,000 people died, enough to contribute to a decline in the country’s life expectancy. For a century, this decline remained singular in the annals of American health ― until last month, when the National Center for Health Statistics reported that, between 2016 and 2017, U.S. life expectancy dropped from 78.7 to 78.6 years.
This marks the third consecutive year that life expectancy in the U.S. has decreased, a multiyear drop not seen since that 1918 flu pandemic. And it reflects a longer-term trend in which U.S. life expectancy has lagged relative to other economically comparable countries. Overall, our lives have gotten longer, but at a slower rate than our peers.
Why has U.S. life expectancy slowed to its present reversal? The reasons cited by the National Center for Health Statistics are largely twofold: suicide and opioid deaths. But the real explanation as to why those issues continue to worsen is because America has failed to invest in our nation’s health.
Read the full piece at HuffPost.
When Jeanne Calment was 90 years old she sold her apartment to a lawyer named Andre-Francois Raffray on a contingency contract. The deal was that he would pay her 2,500 francs a month (about $400) until her death, whereupon the apartment would become his. This would have been a nice arrangement for Raffray, were it not for the fact that Calment lived for another 32 years, to the age of 122—the longest human life on record.
At last, Amazon made its decision. After a yearlong search, in which dozens of US cities competed to host Amazon’s second headquarters, the company announced it will build new locations in New York City and Arlington, Virginia. In a statement about the move, Amazon founder and CEO Jeff Bezos said, “These two locations will allow us to attract world-class talent that will help us to continue inventing for customers for years to come…we look forward to becoming an even bigger part of these communities.”
The search took as long as it did, in part, because of the complex political and economic maneuvering necessary to close a deal of this size, and there have been plenty of cynical motives attributed to Amazon’s search for new homes. But there is something more fundamental at play here than just tax breaks and land values.
Urbanization is one of the two most important global demographic shifts over the past 200 years, with the other being the aging of populations. The demographic evidence for urbanization is unquestionable, and well described in an accompanying Viewpoint that appears in this SPH This Week. As urbanization accelerated, the field of urban health emerged around the turn of the 21st century, concerned with understanding how, and why, cities influence health. An appreciation of the role that cities can play in shaping the health of populations is an extension of a growing scholarship around the role of context as an inextricable determinant of the health of populations, the subject of one of my previous Dean’s Notes. In many respects, that cities influence health is intuitive. Cities influence the food we eat, the water we drink, and the air we breathe. Urban living can affect everything from available food to walkability to the spread of infectious diseases. Early writing in the field was focused on challenges to the health of populations in cities, including the coining of the term “urban health penalty.” However, as the field has matured, it has become readily apparent that the relationship between urban environments and health is complex, and that a range of determinants of health, both positive and negative, characterizes the urban experience. In the past decades, an equally apparent “urban health advantage” has emerged where, particularly in high-income countries, overall health in urban areas surpasses that of non-urban areas.
It has become an article of faith that technology will improve the practice of medicine in coming decades. Medicine enthusiastically embraces novel technical approaches that may improve patient care. But what if those technical approaches bring greater scrutiny to clinical work? What if they may cast a harsh light on work that medicine typically does behind closed doors?
Such questions emerge as efforts grow to introduce “black boxes” to surgery.
When an airplane goes down, there is an urgent search for the plane’s black box. The black box contains both the audio recording of all cockpit discussion as well as a recording of flight instrument readings. These two flight recorders are required by international regulation and together offer the best possibility of learning what happened in the minutes preceding any aviation accident or incident.
News that the Australian government has launched a review of free speech on campus is another reminder of just how fraught the question of who gets to speak at universities has become.
Our capacity to participate in an exchange of ideas is at the core of what we do as institutions. But while it is easy to apply blanket support to the idea of “academic free speech”, it is amply clear that, even in the academy, speech is never without limit
During 5 days in October 2018, 3 acts of terror starkly reminded the country once again of the pernicious consequences of hate. Between October 22 and 26, Cesar Sayoc, a supporter of President Trump, is reported to have mailed at least 14 improvised explosive devices to critics of Trump, including 2 former US presidents, current and former Democratic party legislators, and career government professionals who held leadership posts during previous administrations. On October 23, Gregory Bush attempted to enter the predominantly African American First Baptist Church of Jeffersontown, Kentucky, and, failing to gain access, killed 2 African Americans in a nearby Kroger supermarket. Most horrific of all, on October 27, Robert Bowers, entered the Tree of Life Synagogue in Pittsburgh, Pennsylvania, armed with an AR-15 assault rifle and killed 11 congregants and wounded 2 others.
Each of these incidents of terror appears to have been motivated by hatred, on the perpetrators’ part, of groups that were different from them. Sayoc mailed personally packaged explosive devices to individuals perceived to be enemies of the president, his inspirational figure. Bush’s shooting victims were African Americans. Bowers trained his weapons on persons of Jewish faith as they worshiped. All 3 incidents represent targeted efforts to kill those who were other than the perpetrators themselves. All three occurred in the context of a multiyear rise in hate crimes, particularly featuring incidents directed against Jews, Muslims, and LGBT people, among others. The year 2017 witnessed the largest 1-year increase in anti-Semitic incidents since auditing began more than 40 years ago.