Community voice
by Kathleen Rowe, MPHc What if I told you there was a disease that killed 32,000 , injured 2.3 million Americans, and cost our nation a staggering $836 billion (in both economic and loss of life costs)? What if this disease, and its resulting injury, disability, and death, disproportionately burdened our children, elderly, poor, and non-white communities? Would the public panic? Would public health professionals declare this disease an epidemic?
Well, here’s the good news: 1) What I just described to you is actually 100% preventable and 2) It’s not a disease either. It's the mortality, morbidity, and economic costs associated with our county’s transportation network and its dependence upon motor vehicles. Here’s the not-so-good news: Transportation indirectly affects our health too. And I’m not just talking about the air pollutants in motor vehicle emissions and the environmental costs of the manufacturing and maintaining motor vehicles. Nor am I talking about the direct effects of prolonged motor vehicle operation, which include higher rates of cardiovascular disease, stress, obesity, and colon cancer. I’m talking predominately about the fact that transportation is a social determinant of health. The quality of our transportation system determines the means and methods through which we access resources, and how and where we are able to travel to. In simpler terms, transportation directly affects our access to food, employment, education, and health care. Transportation systems are also inequitable. America’s current transportation system is financially incentivized to favor motor vehicles. To use a motor vehicle, you must have the privilege and resources to learn how to drive, get licensed, and purchase a car. Side note: my statements do not neglect that America (NHTSA) has taken steps to improve the safety of its transportation network by implementing consumer safety standards for motor vehicles and directly incentivizing state-level seatbelt and child car seat laws. These regulations are arguably some of the most prized public health accomplishments of the 20th century. They have greatly reduced the direct burdens of transportation on our population’s health. But are they enough? Do we Americans really think that 30K deaths per year are an acceptable cost for us to travel from point A to point B? Apparently so, as most of us Americans label motor vehicle crashes as “accidents”. In fact, some of our largest and most popular media outlets label motor vehicle crashes as accidents. In 2016 alone, NPR, The New York Times, The Chicago Tribune, and CNN (just to name a few) have wrongly referred to transportation crashes as “accidents”. When we talk about motor vehicle crashes and call them “accidents”, it semantically implies that our society accepts these deaths and their costs as “sh*t happens”. The word ‘accident’ itself implies that nothing could have been done to prevent it; that it would happen no matter what preventative measures were initially in place. Furthermore, it implies that our society accepts its consequences that negatively affect our health. However, this is simply not the case - it shouldn’t be the case. So, how does a public health professional advocate for a safer and more equitable transportation system? I have three key pieces of advice: 1) They’re not accidents, they’re motor vehicle crashes. Don’t hesitate to correct anyone and everyone when they falsely use that A-word. 2) Get woke, stay woke, and get others to wake up. Do your research. Click on any of the references I listed above and educate yourself, and don't be afraid to spread the word. If you’re really passionate, educate yourself on what our European friends have done to make their transportation systems safer and more equitable. 3) If you drive a motor vehicle, especially in an urban setting, please be aware of the privilege you have. Look out for the most vulnerable road users (pedestrians and cyclists) and don’t forget to share the road. Safe travels! by Brenna Aumaier, MPHc, CPHp
Sex trafficking is bad, we can all agree on that. Are sex trafficking and stripping (ie. legal sex work) synonymous? Doubtful. As a public health researcher, and an advocate for sexual and reproductive justice, I have studied sex work extensively. The ACLU describes House Bill 262 has proposed legislation that “mandates employees of adult-oriented establishments to register with the state. It also bans alcohol in the establishments and creates a buffer zone of six feet between patrons and nude entertainers.” This potential regulation is an insult to feminism and an affront to a perfectly legal occupation. Research does not suggest that any of the listed activities are bound to or indicative of sex trafficking. This is a paternalistic ploy to hinder and dismantle the only existing industry in which women can regularly make more than men without education or other qualifications. The stripper registry is problematic for a few reasons. Not only does it place sole responsibility on the women (don’t men work in strip clubs too?), but also requires women to have their legal names, stage names, addresses, phone numbers, criminal history, and their place of work compiled in a registry that would presumably be public record. Sexual assault is already a major concern for women in general, and more so for women who engage in sex work. Access to home addresses puts women and their families (i.e. children) at risk for harassment, robbery, sexual assault, etc. Further, it can be problematic when women transition from sex work to traditional employment or seek housing and are subject to background checks. One’s right to privacy is not conditional based on occupation. In 2014 Washington dancers banded together to sue against the release of their information to a man who filed for access to their registry to “pray for them.” There is a reason girls don’t walk to their cars alone after a shift, but PA wants to give people their home address? This is direct contradiction of the “protection of women” angle supporters are going for. The proposition to ban alcohol sales also eliminates millions of dollars in tax revenue just in alcohol sales alone from “adult” establishments in Pennsylvania. PA is not the first state to propose such a bill. In 2007 Dancer’s for Democracy fought against the proposed “6-foot rule” by arguing that this regulation would significantly reduce wages and force dancers into minimum wage jobs or welfare. This is not a protection, but a thinly veiled ploy to keep men out of strip clubs. While the bill states “it does not intend to restrict persons from voluntarily seeking employment in adult-oriented establishments,” it certainly would act as a deterrent for PA based legal sex workers who don’t have or prefer the option of traditional employment. Many women who work in this largely night based industry have overcome stigma and slut shaming so they can spend their days with their children, or studying for college courses. And with so many states in such close proximity to PA, it would drive dancers and customers to New Jersey, Delaware, and New York based establishments to avoid the imposing regulation. This is problematic as it increases night time travel (decreasing road safety). It should be noted that stricter regulations on sex work actually increases women’s risk. By reducing clientele, women are forced to interact with clients they might otherwise avoid. These types of legislations harm women engaged in sex work rather than help them. Increased criminalization results in fear of reporting sexual assaults, reduced likelihood of seeking medical care, and increased stigmatization. If you want to protect women, reduce the stigma, make it easy to report assault, train police to deal with sexual assault of sex workers, make it unacceptable to hurt a sex worker, educate club managers about the signs of trafficking, crack down on clubs that allow prostitution. But don’t put women’s safety at risk. by Jerry Fagliano, Ph.D., M.P.H. Chair and Associate Clinical Professor Department of Environmental and Occupational Health Dornsife School of Public Health at Drexel University By now, the story of Flint’s water crisis is well known. In April 2014, the City of Flint switched its drinking source from treated water purchased from Detroit to water from the Flint River. Inexplicably, the switch was made without ensuring that the new water source had proper treatments to prevent corrosion of metals from street mains and plumbing (1).
Residents began complaining about water quality soon after the switch. After local and state officials were slow to respond to increasing public concerns, Virginia Tech researchers partnered with Flint residents to show elevated levels of lead at residents’ taps due to corrosion of lead service lines and plumbing. About one-fifth of tested homes had a tap sample with lead above the U.S. Environmental Protection Agency’s action level for lead of 15 micrograms per liter (µg/L), double the proportion allowed to be over this limit (2). Before Flint, there was remarkable progress in removing lead from children’s environments. In the late 1970s, almost all children had blood lead levels (BLLs) above 10 micrograms per deciliter (µg/dL). Today, almost all children have BLLs below 10 µg/dL (3). The three most important actions responsible for the dramatic change have been: 1) the phasing out of lead from gasoline, 2) the banning of lead as a pigment in residential paint, and 3) systematic child screening for exposure and follow-up environmental actions to ensure lead-safe or lead-free housing. Reflecting this national trend, Michigan’s lead screening data had shown a steady reduction in children’s BLLs over time, in both Flint and the State. In 1999, over 40% of Michigan’s children had a BLL over the current CDC reference level of 5 (µg/dL); by 2013, this proportion was reduced to well under 5% (4). Dr. Mona Hanna-Attisha, a pediatrician at Hurley Medical Center in Flint, compared children’s BLLs before and after the water switch (5). Her analysis showed that the percentage of children above 5 µg/dL increased from 2.5% in 2013 to 5% in 2015, with bigger increases in parts of Flint with higher measurements of drinking water lead. These data demonstrated a reversal in lead trends, setting back hard-won progress by years. Amid intense public pressure, Flint reconnected to Detroit water in October 2015. However, damage had been done. The cumulative effects of months of pipe corrosion will take months to reverse, and the erosion of public confidence in water and in government officials nationally has been severe. The effects of exposure in children and adults are, unfortunately, well-known. Very high lead levels can cause kidney damage, serious brain injury, and death. Particularly for infants and children whose nervous systems are rapidly developing, it is believed that there is no safe level of lead exposure. Even at the lowest levels there are subtle but measurable impacts on neurodevelopment (6). Living in older housing with peeling leaded paint—associated with living in poverty—remains the strongest determinant of elevated lead exposure (7). However, the relative importance of drinking water as a source of lead is increasing. Drinking water delivered by community water systems through street mains is typically free of lead. But, lead can get into drinking water through the corrosion of lead service lines—pipes owned by homeowners that connect the street main to the building’s plumbing—or corrosion of lead-soldered copper piping within buildings. There are still several million lead service pipes in the U.S., and countless homes with lead-soldered copper (8). Fortunately, there is a remedy: the Safe Drinking Water Act requires water treatment to greatly reduce the corrosive tendency of the water, by causing a protective mineral barrier to form on the inside of pipes and fixtures, effectively shielding the component metals from the water (9). In Philadelphia, the city water department reports that its tap water samples have been in compliance with the lead action level requirements since 1997, through corrosion control treatment (10). Still, corrosion control is not perfect, so additional actions are needed. In the aftermath of Flint, the Philadelphia Water Department has initiated a program to replace lead service lines for free wherever water main replacement work is done; meanwhile, it is offering no-interest loans to residents who want to replace lead service lines quicker. It is important to note that complete elimination of lead service lines would not take away the need to control water corrosion. However, there are steps that individuals can take to reduce the potential for exposure to lead, beyond the protection provided by corrosion control treatment: 1) run the kitchen cold water tap for a minute in the morning to reduce the amount of lead before using the water for drinking or cooking; and 2) never use hot water taps for drinking, cooking, or preparing beverages, especially infant formula. Schools with extensive pipe networks but relatively low water flow may be at highest risk of having elevated lead levels at the tap. For this reason, school facility managers should institute daily tap and fountain flushing programs, following guidance by the U.S. Environmental Protection Agency (11). Day care centers, which care for a particularly susceptible population, should also undertake flushing programs to ensure that water available to children has had minimal contact time with pipes. By taking these actions to reduce exposure, we can protect our nation’s children from the harmful effects of lead. References (1) Michigan Radio. Timeline: Here's how the Flint Water Crisis Unfolded. Accessed at: http://michiganradio.org/post/timeline-heres- how-flint- water-crisis- unfolded#stream/0 (2) Flintwaterstudy.org. Lead results from Tap Water Sampling in Flint, MI. Data set accessed at: http://flintwaterstudy.org/2015/12/complete-dataset- lead-results- in-tap- water-for- 271-flint-samples/ (3) Brown MJ and Margolis S. MMWR August 10, 2012;61:1-10 (4) Michigan Department of Health and Human Services. http://www.michigan.gov/mdhhs/0,5885,7-339- 73971_4911_4913-- -,00.html (5) Hanna-Attisha M. Am J Public Health 2016;106:283-290 (6) Advisory Committee on Childhood Lead Poisoning Prevention of the Centers for Disease Control and Prevention. Low Level Lead Exposure Harms Children: A Renewed Call for PrimaryPrevention. January 4, 2012. Accessed at:http://www.cdc.gov/nceh/lead/acclpp/final_document_030712.pdf (7) Jones RL et al. Pediatrics 2009;123:e376-385. (8) Rabin R. Am J Public Health 2008;98:1584-1592 (9) USEPA. https://www.epa.gov/dwreginfo/lead-and- copper-rule (10) Philadelphia Water Department. Meeting the Lead Standard. http://www.phila.gov/water/PDF/LeadStandard_2015.pdf (11) USEPA. http://nepis.epa.gov/Exe/ZyPDF.cgi?Dockey=P100HGM8.txt |
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