Day 6(1/8/18) *Atlanta/CDC*

Day 6 :) Late start this morning due to....freezing rain! So our case study was cancelled but thankfully we could still hear from all of the speakers scheduled for the day(except for one who stayed home with his kids--school was cancelled today). Here they are:

Elizabeth Lundeen(MPH, PhD): Health Disparities

Dr.Lundeen's talk fit in a lot of topics for just being an hour long-impressive! She told us about chronic illness, obesity, determinants of health and disparities, Atlanta public health efforts, obstetric disparities, food access programs, and gave us some great book suggestions (a summer project for me, perhaps, to read them all?) She discussed that each year in the US, we spend $147Billion on obesity-related issues, and that we spend $117Billion on healthcare costs related to inadequate physical activity😬. Because of the determinants of health (socio-ecological such as race class, sex, job, etc. and medical such as health behaviors and access), she emphasized that lots of the healthcare dollars, mostly related to obesity and physical activity but also to others, are spent mostly on the people who are affected negatively by the determinants of health. Unsafe housing, for example, can lead to asthma, lead poisoning, obesity, diabetes, and physical injury. Additionally, people who have unsafe housing will likely have a low income, and therefore poor access to healthcare(both geographically and financially). For example, pregnant women in these areas are opting more into planned C-Sections because their houses are so far away from hospitals that they worry that they won't make it to the hospital in time to give birth! So...what to do about this issue? Last year, in the public health class(ID245), we learned about the answer to that question for an entire semester, and barely uncovered the tip of the iceberg! 

However, she did offer a few hopeful efforts that may help: in Atlanta, the "beltline" is a transformed abandoned railroad that surrounds the city that now serves as a bike/walk/run path so that more people can access a safe place in which to exercise. She also discussed the mixed-use housing model, in which grocery stores have housing directly above them so that people can be close to fresh produce to eat (since the low-income population is more likely to live in a "food desert"-an area in which no fresh produce is available to buy for miles). Another project is to diagnose malnutrition and “prescribe” fruits/veggies as the treatment-vouchers that a pharmacy must fill and that the patient can redeem for produce! While I am sure that there were many other efforts, there still exists a great disparity in health between low- and high- income individuals in the US, and it seems that it will have to be a mix in policy change and on-the-ground environmental change: I hope that one day I can be a part of one of these efforts in the future, because learning about the disparities makes me feel like that is where everyone's efforts need to lie in order to help our fellow citizens(and ourselves) and future generations.

**Book suggestions from Dr.Lundeen:

-"The Lancet: Equite and Equality in Health" (journal)

-Nickel and Dimed by Ehrenreich

-The Color of Law by Rothstein

-Evicted by Desmond

-The Working Poor: Invisible in America by Shipler

-The Healing of America by R.R. Reid

-Bowling Alone by Putnam

Interesting side note about Dr.Lundeen's talk: she said that 36% of the Native American population experiences a longer-than-expected delay when they check in for medical care at any clinic; since I am interested in working in New Mexico next year, where several tribes live, I was intrigued by this statistic. Perhaps next year, if I end up in New Mexico, I can learn why that is. It's frustrating, since other ethnic groups experienced far smaller of a percentage.

Melissa Rolfes(MPH/PhD): Stories from Ebola deportation

Melissa, our host, then talked about her Ebola deportation! That was really interesting. (I feel like a broke record saying "this was so interesting!" over and over again---but it's true, it is all so interesting!😄) Melissa was deported to Sierra Leone in her first year at EIS and was abroad for a few months...she had to leave her 1-year-old child and her husband for that whole time-very selfless of her to care about public health that much to sacrifice such a long time away from her husband and baby..I don't think I'd be able to do something like that-I suppose I won't know until/if the opportunity presents itself, but that is a great example of humanity that she did! Melissa told us that she worked with Dr.Ian Crozier, a doctor who came back to the US and had contracted Ebola, was placed into a coma, and after months of treatment, finally recovered. Unfortunately, this is a sad reality; she said, that the more you care in epidemics(as in, care for patients), the more at-risk you become. That comment got me wondering about whether that's a trend in professions in general: is it true that the more invested in your work you become(or the more you care), and the more projects you take on, the more at-risk you become for developing stress-related issues? I know it's not the same as working with epidemics and diseases, but I wonder if there's a similar trend.

Jennifer Nelson(MD/MPH): Nutrition and Breastfeeding

Dr.Nelson is a St.Olaf alum! Her first piece of advice to us was: “No decision you make is final.” and then went on to tell her about her winding road that lead her to her current position at the CDC. Great advice, especially since most of us in the room were going to graduate within a few semesters, and sometimes it feels like what we decide to do immediately after college will become our future—which can cause unnecessary stress! Anyway, Dr.Nelson talked about breastfeeding and infant care-the majority of her work lies in recommendations surrounding breastfeeding and education on its importance. For the other speakers, I’ve been condensing my summaries to make more room for reflection in my journals, but for Dr.Nelson’s talk, I really want to highlight everything she talked about because it was all so relevant—so pardon the more-lengthy-than-usual summary section coming up!

-There is a $3:$1 return on investment in companies who support breastfeeding initiatives in their offices

-82% of moms in the US initiate breastfeeding, but only 25% continue past 6 months

-I wonder if this includes incarcerated populations? I asked Dr.Nelson about this, and she said that because of the CDC working on “big picture” trends, they didn’t focus on incarceration breastfeeding. I’d be interested to find out what % of incarcerated women are mothers to children >1yr old, and to identify whether this population indeed is a significant percent of the overall population or not. 

-CDC recommends 1 year of breastmilk (6 mos. exclusively breastmilk), WHO recommends 2 years

-I wondered about the difference in opinion…perhaps the WHO recommends 2 years because in Europe women have far better access to maternal leave so this is feasible? Or perhaps it costs less to breastfeed so mothers are encouraged to use it as often as they can, to avoid unnecessary costs? Not sure, but I’d be interested to find out more about this!

-“Rooming-in” is recommended so as to promote breastfeeding and parent-baby bonding. This means that the baby is delivered and kept in the same room as its parents until discharge from the hospital.

-This is the policy at HCMC! (where I interned this summer)

-By breastfeeding, the mom has a lower risk of heart disease, cancers, and high blood pressure, and the baby has a lower risk of infection, attachment disorders, and skin issues!

Candice Robinson(MD/MPH): Vaccines

Dr.Robinson discussed the process of creating vaccine recommendations and schedules. Apparently there are several committees that meet each year at the CDC to develop new recommendations and analyze data they have received in the meantime. The people who sit on these committees must be non-government workers, and depending on the committee, they have regular meetings(such as those on the flu vaccine committee) or as-needed meetings(such as those on the encephalitis vaccine committee). Either way, all committees meet annually at the CDC where they discuss how to proceed for the following year’s recommendations. They are live-streamed and open to the public, so perhaps I’ll be able to watch some of the meetings!🤓 They’ll be on February 21 and 22, 2018 and the stream is found on the CDC website!

Candice was talking about the fact that some anti-vaccination advocates attend the meetings and sometimes express their anti-vax opinions during breaks; I was really frustrated by that at first, but it reminded me of a paper I wrote in my bioethics class. The paper examined why people would be apprehensive towards vaccines and thus protest against them, and I found that communication between both sides to correct any misconceptions about vaccination myths actually can strengthen the vaccination movement in the end. So, I think it’s good that the CDC lets these people come to the meetings to encourage education and hopefully decrease apprehension/fear in the anti-vaccination community :) 

Kristin Vanderende(RN/NMW/PhD): Polio Eradication

To finish off the day, we heard from Kristin. It is such a privilege to be here, and I fully realize that-but by the end of the day my brain was a little fatigued from all of the impressive talks(it’s like being in a museum-it’s incredible, and the work that people have put into it is beyond comprehensible, but after a while you get a little brain tired 😂. Anyway,  Kristin was the perfect cure to that! Her energy was so contagious, and she seemed to be the type of person who is so in love with her job that it’s rarely ever a chore.

Kristin’s work was in polio eradication(the only disease ever to be eradicated was smallpox), and she said that since 1988 when the polio eradication efforts began, the world has seen a 99.9% drop in the prevalence of polio! Today there exist only 20 cases, but it’s a disease that could exist in very large numbers again. Therefore, the CDC has significant efforts in place across several countries for mandatory reporting of symptoms and testing. Often, these patients suffer from a disease with similar symptoms to polio, but are not the disease itself. I asked what the CDC does in order to treat these patients, since they(the CDC and WHO workers) must go to very remote areas of the world to test the suspected cases, and she said that it is beyond their resources to provide treatments. This made me think of what it must be like for the patients and their families—seeing a public health worker come to their house in the middle of nowhere, and who only is there to prevent the spread of the disease. Likely there are local hospitals that can help, but it still must be quite sad for the patients to not be helped directly by the CDC (but rather by large-scale efforts to implement policies to prevent the disease). The work that these CDC workers do is so necessary and incredibly important, my heart just breaks for those who it doesn’t help immediately (I do understand that they do incredible work, and I am in no way criticizing it-as I’ve mentioned before, the people who we’ve met are heroes to the health of the human population, it’s just sad that there can’t be a quick way to help everyone AND prevent further disease is all I’m trying to get at).

**She said that the US had a rise in polio after the vaccines were introduced, followed by a fall. This could have to do with passing vaccine resistance through breastmilk, or with a vaccine batch that accidentally was active.

After a talk-heavy day, I am thoroughly impressed with how many ways there are to work in public health, and I look forward to learning about more tomorrow! We're going to attend a CDC meeting tomorrow and then talk with a panel of EIS officers-I'm interested to see such an official function as just a visitor!

Goodnight,

-Anna