Another sugary drink freak-out

A couple weeks ago in my Program Planning class, we discussed whether people on food stamps should be prohibited from purchasing sugary sodas with their government assistance. I've included my thoughts on the matter below (based on our "thought paper"). I also thought it worth noting that NBC recently reported that EVERYONE who drinks sugary soda, even if they're not dethfatz, is going to die because of their bad dietary choices (see link here).

Personally, I love how the article seems so incredulous about the fact that even skinny people can die from heart disease. What, it's not just for fat people? Who knew?

This just proves that we don't have a handle on the risk factors for heart disease, despite our scientific clamor to blame the fats. I particularly love this line:

All the more reason why women might want to be careful with a soda habit, Coulter said. "The message is that women have smaller frames then men, and therefore need more calorie restriction," she said.

I love it when people tell me to restrict my intake. Not.

Furthermore, I'm consistently irritated by the fact that we focus so much on chronic conditions such as diabetes, heart disease, etc., when those are simply the major killers of OLD PEOPLE. Wanna know what causes our nation's youth to kick the bucket? Accidents. Trauma. Tragic injuries. And by young, I mean under 35. Car crashes? Yep, they kill a ton of people. More people than heart disease. But you don't see public health officials jumping on the auto safety bandwagon with nearly the enthusiasm that they attack our food/beverage/drug consumption.

Should it be illegal for people on government assistance to drive cars? Those are far, far more dangerous than sugary sodas. You have the potential to kill someone else with that mobile death trap. Soda? C'mon, guys. I know it's not a popular viewpoint, but I have to believe that we have bigger fish to fry. Educate people about the risks of drinking these beverages, and then leave them the hell alone to eat what they want. That's what adults do, anyway.

#sickofthealarmistculture

Thought paper: Should people on food stamps be able to purchase sugary drinks with their government aid money?

Restricting access to any kind of food makes me instinctively bristle. Who am I, even as a public health professional, to dictate what people consume? My job is to make sure that people are informed about risks so they can make the decisions that suit them. Limiting food choice, even by restricting sodas, seems to be an overly paternalistic attitude that contradicts the very fiber of the American spirit.

I once dated a young man who was Type I diabetic. I always thought sugary sodas were so bad and that they didn’t have any place in anyone’s diet. That all changed when I realized that Sean could avoid a serious medical problem by simply drinking a sugary soda or eating a candy bar. He had very brittle diabetes, and without candy and soda, he would have sustained a significant amount of damage to his body. Soda saved him from diabetic emergencies more than once during our relationship. In fact, he would have cost the health system more if he wasn’t allowed to consume soda because he would have been hospitalized more frequently.

Our job as health professionals is not to hand down edicts from ivory towers, but rather to compassionately educate. The people who are purchasing the soda are presumably adults; it’s their prerogative to consume what they want. They might need soda for their physical health (like my ex-boyfriend), or they might need soda for their mental health (it tastes delicious and makes them feel good). We have done our job as public health professionals if we teach adults to engage in healthy, moderate diets that allow for “sometimes” foods like carbonated sugar water. You can get fat from eating too many hamburgers, but you can also get fat from eating too much free-range chicken or low-fat milk or peanuts. You can also, strangely, benefit from soda in your diet, depending upon who you are. (Here’s another “it depends” … you just can’t seem to escape them in public health).

Consequently, I also don’t believe that we should deny public assistance to people who test positive for drugs. Rather, we should provide them with viable alternatives to drug use. We should give them compassionate care that fits their situation. I sincerely doubt that the junkie down the street says, “Oh, well, my social worker and that public health lady over there say I should stop doing drugs, so I’m cured! Hallelujah!” Depriving these people of the resources they need is just flat-out inhumane.

Who do you think the neediest people are? I’d assert that many of them are substance abusers or even (gasp) people who drink soda. When we look down from our perspective of privilege, throw patronizing policies at them, and chastise them as though they were children, we completely discount their experiences. “We know better than you!” we say, and we wonder why these populations don’t trust our opinions or recommendations. Frankly, I don’t know better than them. I don’t know what it must be like to try to kick a meth habit and rely on public assistance to eat. I don’t know what it would be like to be diabetic, lack access to juices, and be unable to get candy or soda for my health. The best thing we can do as public health workers is to provide people with the opportunities to make the best choices for themselves. They’re adults, and this isn’t the novel 1984. As Ragen Chastain said a couple weeks ago, “I’m the boss of my own underpants, and you’re the boss of yours.” That’s a policy I can get behind (pun intended).

A brilliant thought that just occurred to me ... a note on culture

As a public health professional, I have been indoctrinated to continually consider culture and heritage as a part of interventions. We should, our professors say, carefully examine the normative values immanent in our target populations. We should analyze and plan and really, really think about not only what we say, but how we say it, and how we act when we do so. It's all about sensitivity.

I was thinking the other day, then, about the classroom environment and different teaching styles, and how professors should really be applying these same principles of cultural sensitivity to their students. We are, as master's students, existing in our own culture. We have specific norms and values, specialized language that describes our experiences, and certain socioeconomic concerns (i.e., we're generally poorer than poor). We have arguably created our own subset of society here in our public health school.

Why do I get the impression, though, that some ostensibly enlightened educators are contradicting their own teaching by refusing to understand students' viewpoints? I wouldn't necessarily call it hypocrisy, but I just don't understand how students at SRPH don't constitute a population that deserves consideration on par with needy community members. We're a group of people with specialized interests, and we ought to receive "interventions" (in this case, education) that has the same quality of the interventions we are designing in our courses. We don't berate or belittle people for doing things "wrong" in a health setting; why would we do this to students, who occupy an analogous social realm?

I'm going to bust out an old cliche: Practice what you preach! That's an imperative that is imposed on all of us that are in the health and wellness industries. Like it or not, people are unlikely to trust a nutritionist who only eats cupcakes, a doctor who smokes, or a public health professor who doesn't attempt to understand students' very legitimate cultural norms.

This is what we are called to do, thinking outside of the box. Cultural sensitivity isn't only good for understanding life in the colonias or in other countries, it's important right here in your own backyard. Learn how to apply it in your immediate surroundings, and you're certain to succeed when the tough situations arise.

I've come to the conclusion that being proficient at public health is really just being proficient at life. Here are the basic tenets of our profession, as I interpret them:

• Ask people what they want and need,
• Be nice,
• Try to understand people that are different from you,
• Admit that you don't know everything,
• Admit that you sometimes break things,
• Don't lie,
• Don't waste money or resources,
• Make sure what you're doing is working,
• Don't hurt anyone,
• One size does not fit all.

Were I a public health professor, I would give my students this list and then turn them loose to study whatever health topic they found interesting. I would give them the freedom to intuitively create interventions and then provide constructive feedback. This field isn't about following a formula to achieve a prescribed end. It's about engaging people and showing them that they can change their own health status and maybe even that of their community. It's about coming up with effective, exciting, and innovative ways to get things done.

It'd be great if that started at the institutional level, but I'm running out of faith that academicians can deliver what people really need. If they can't even get it right in the classroom, how can they get it right in the real world? Tough questions.

"All you have to do is ..."

During my second semester of graduate school, my department head said something particularly insightful that I believe will stick with me during the rest of my academic and professional careers. He told us during class that anyone who says, "All you have to do is ..." to fix a public health problem is frankly an idiot, and we should stop listening when we hear those words. Although I don't always agree with my professors, I thought that was a heck of a comment.

This type of attitude is rampant among the general public, but it also insidiously invades academia. "All you have to do is get people to lose weight to lower mortality rates." Well, yes and no. Maybe.

It depends. (FYI, that's the answer to everything in public health. It just effing depends.)

I have been in the fatosphere and other radical public health communities for a couple years now, and it always shocks me when people take traditional viewpoints about obesity and other public health concerns. One professor told me he was talking about sizing chairs for a growing population, and almost the entire class took the "blame the victim" approach, calling for people to lose weight instead of making sturdier furniture.

I wonder if most public health professionals have ever tried to perform the behavior that they are asking of others. I have quit smoking, recovered from an eating disorder, lost 30 lbs., started a vegetarian diet, and lowered my risk-taking behaviors during the past 5 years. These experiences have all given me an authority to speak to how difficult changing your life can be. Do you know how many times I've tried to quit smoking? Because it's too many for me to count. I've stopped for up to 3 years at a stretch, only to cave during a particularly difficult time in my life. I wonder if anyone in my classes has had this problem, as well.

Without these first-hand experiences, I think it would be awfully hard to tell people what they should be doing to improve their health. If you've never had to make an invasive behavioral change, how can you expect to explain the importance of your initiatives to people in the midst of health problems? What kind of credibility do you have? It seems a little paternalistic and insulting to hand down these health edicts without first understanding the context of the situation.

So there's my little rant for the day about how we have the responsibility to relate to our target populations ... and if you can't, then stay the heck out of their business. I don't need someone to insult me into reaching a "normal" BMI, and I don't need someone who's never picked up a cigarette to tell me how bad smoking is. Don't tell me to wear a helmet or drive slower if you've never had the gall to go fast, just once.

"All you have to do is ... empathize with your target population?" Seems about right to me.

It's Weight Stigma Awareness Week! Are you participating?

So, I recently found out that October is pretty much the coolest month ever, what with the Fat Talk Free Week coming up and now Weight Stigma Awareness Week!

To kick off our post about these awesome initiatives, why not throw in some pictures of headless fatties:

Because fat people don't deserve to have their faces shown. They are soooo grotesque and obnoxious that we don't want to see their faces. Yuck.

Great, now that it's out of our system, let's talk a little bit about weight stigma and how it relates to public health.

This past week, we hosted Ragen Chastain of Dances with Fat, an exciting blog that talks about obese peoples' health experiences. She spoke at the School of Rural Public Health about how obesity is itself not a health concern; rather, obesity can be a symptom of an underlying health problem. In fact, you can be obese and be more healthy than someone in the "normal" weight range.

Weight is, alone, not an indicator of health. There are all kinds of unhealthy people out there in the world, and they all fall into different weight categories. The BMI was never meant to be applied to individuals, but is rather a population-based measure of body size.

I feel like I've heard or said this all before ....


Anyway, I'm glad that someone came up with this initiative. As a former Fat Person, I can attest to the fact that people treat you differently when you gain a crap-load of weight. I've had doctors tell me to just "eat less and exercise more," or "you're not trying hard enough to lose the weight." Too bad my 40-lb. weight gain in 6 months was due to a hormone condition, not my diet. Now that I'm on medication, my weight and cholesterol have dropped, and I'm healthy again.

This issue is particularly close to my heart because of my personal experiences with being chastised for being fat. I was fat because I was sick, not because I made poor health choices. But even if you are fat and unhealthy, it's no reason to BLAME someone or treat them with disrespect.

Healthy People 2020

Healthy People 2020

Check out this insightful post about Healthy People 2020 from our friends at the Disruptive Women in Healthcare blog. These gals have put together some very cogent arguments and thoughtful observations, and we're excited to share their ideas with you!

The great academic contradiction: Politics make an appearance

As the president of our public health school's student council, I am both responsible for the welfare of the student body and accountable to our faculty. That's fair. But I am experiencing a significant crisis of faith because of the contradiction between what our professors tell us and what they actually expect us to do.

At my new student orientation, I was told about the importance of "getting involved" in my community; how, as a public health professional, my unwillingness to assist others would portend career failure. I was admonished for not immediately accepting leadership roles (although I've since assumed a great deal of responsibility here at SRPH). Further, our teachers consistently tell us to improve our community awareness, involvement, and interaction to ensure future success in our career fields.

Yet, it seems that when we attempt to take these ideas for a test drive at our own school, politics get in the way. Professors think your strategic marketing plan steps on their toes. They dislike your initiatives that are aimed at breaking down the "silos" that inhibit public health from making a real difference in many community settings. They balk at your initiative, optimism, and enthusiasm. I resent this a little.

This prevailing attitude only reveals the true advocates in our midst. Despite the dissident population, I have received support from a few dedicated faculty who encourage innovative solutions to public health problems. They recognize the potential that our generation has to effect change in our world, in spite of our tech-based upbringing. I am thankful for these people.

I guess the point of this post is that I'm consistently shocked by the negativity leaders display when you do what they tell you to do. My professors want to break down barriers between departments and disciplines? When we start doing this in our student council, let us do it! We are an interdisciplinary group, and by golly, we ought to acknowledge that fact.

The imperative for change thus falls on those stalwart supporters and energetic motivators who truly want to change the face of health in our nation and world. Sure, we give lip service to innovative solutions to public health problems, but most of us in the academic establishment seem to want to spend time in our happy little laboratories drawing models and filling in charts, pondering our navels instead of actually making a difference. It seems like we're just spinning our wheels in so many ways because of political considerations.

It's going to be like this in the real world, I know, so it's almost better that we're facing it now, in school, but for a starry-eyed idealist like myself, this whole process takes a little bit of the luster out of the profession.

Tuberculosis: It's all the fashion rage!

In last night's epidemiology class, my professor said something very insightful. We were talking about Victorian era public health, and somehow beauty standards were tossed into the equation. To paraphrase, he said:

The Victorian beauty ideal, at least for Caucasian women, was thin, frail, and waif-like. This, coincidentally, described a woman with tuberculosis.

That comment sparked a massive internal dialogue for me. So much that I could barely even focus during the rest of class. It was as though all of the ridiculous beauty standards to which women are upheld were suddenly flashing before my eyes, bolstered by historical precedent. Painful beauty routines for women are ubiquitous throughout cultures and geographical distributions. These aesthetic requirements even cause us to compromise our health.

Women's pursuit of beauty could very well kill them.

The Victorians thought you looked great if you had a deadly respiratory disease. Really. That's what they considered "hot." Is it so different in other countries? Not really. The implications of this statement, aside from the obvious eating disorder concerns (which may or may not be related to "beauty," but that's another topic), are massive!

I thought about

• Foot binding: crippled women
• Genital mutilation: dehumanizes women
• Permanent makeup: tattooing our faces! ouch!
• High heels: cripple women still
• Corsets: caused us to faint and put unnecessary pressure on our internal organs
• Waxing: self-explanatory pain. Also, makes us look like pre-pubescent girls if performed on certain body parts (which is creepy!)
• Hair products: exposure to potentially carcinogenic chemicals
• Parasites: to help us lose weight (yep, seriously)
• Lysol: to make our vagina smell fresh (also, yes, seriously)

This list doesn't even include the weird devices we use:

Anyway, maybe you all already knew everything I'm writing about, but the enormity of this topic really just sank in last night. It was like getting hit with a brick wall.

I think those of us in the public health professions have a responsibility to promote healthy beauty ideals, not those that harm us. In light of the recent obesity freak-out, I think it's critical for us to maintain a skeptical perspective about what's "good for us." I'd rather be killed by Teh Dethfatz than an intestinal tapeworm designed to keep me slim and trim. Just saying.