Blog #12: Key Determinants

Problem Definition: There are relatively high rates of children testing positive for lead poisoning in Baltimore city during the years 2005-2007.


Biological/Developmental
Children ages 6 years and younger are greatly impacted by lead poisoning as compared to adults. Also, pregnant women are also affected. The effects that can be warded of by older children and adults can cause extensive brain damage in a developing child. Lead enters the body through inhalation or ingestion. Small children and pregnant women absorb at least 50 percent of the lead that enters their bodies. The lead absorbed travels through the blood stream and places itself in soft tissue, like that in the liver, kidney, and brain. Most of the lead that enters the body is stored in bones and teeth. Lead in these areas can be stored for 30 years and be released back into the bloodstream during times of high stress such as pregnancy. Lead harms the brain and nervous system, and also damages red blood cells and kidneys.

Social and Cultural
Children in lower income areas are more at risk to be poisoned by lead because they are more likely to live in rundown buildings and apartments which have higher level of leads than necessary. About 20% of residents in Baltimore live with incomes below the poverty line. 9.4% of residents live with incomes below 50% of the poverty line.

Environmental
Baltimore city is an urban area with great amounts of lead still prevalent in homes. Lead paint in homes was not banned until 1977- so about 80% to 90% of the housing stock in Baltimore City contain lead. Lead exposure can come from the home and the outside environment. A major source of lead exposure for millions of Americans water contaminated with lead from lead pipes or from lead solder used with copper pipes. Lead can be found in soil, yards, and playgrounds. Lead can also be found on old painted furniture, toys, and imported children’s jewelry and imported ceramics. Invisible lead dust is released when lead paint is peeling, disturbed, or damaged. This happens most often by the opening and closing of windows and doors.

Economic
Fixing or renovating your house to eliminate these problems can be costly. Average lead paint removal for a standard home built before 1978 is between $10,000 and $30,000. Another option called encapsulation, which applies a “liquid coating of paint that forms a water tight jacket over lead paint,” costs between $600 and $1000.  20% of residents in Baltimore live with incomes below the poverty line. Standard precautions can be rather expensive, totaling over thousands of dollars regardless of which option is chosen- thus putting low-income families in a position to forfeit these changes.

Political

Maryland Reduction of Lead Risk in Housing Law, otherwise known as the Maryland Lead Law. The goal of this law is to “make all privately-owned pre-1950 rental housing units safer for children, while also helping rental property owners and managers to avoid costly lead poisoning litigation by complying with specific lead hazard reduction measures or a dust testing procedure set forth in the statute.” But, this law only covers rental units.

-Thomasina

Blog #11: Magnitude of My Issue

Problem Definition: There are relatively high rates of children testing positive for lead poisoning in Baltimore city during the years 2005-2007.

The only type of surveillance associated with this issue is mandated testing of children by their family care provider or pediatrician. This mandate only exists in some areas- primarily old cities with housing that contain lead paint, such as Baltimore.


Magnitude of the Problem

Lead poisoning greatly impacts children 6 years of age and younger. When exposed as a child, the implications of lead poisoning include learning  and mental disabilities, lowered IQ, hyperactivity, Attention Deficit Disorder, speech delay, hearing loss, slowed or reduced growth, behavioral problems, and violent and aggressive behavior. According to a study conducted by Dr. Hebert Needleman, the leading researcher on childhood lead poisoning, lead poison is a direct cause of antisocial and violent behavior. Lead poisoning can later cause academic failure and juvenile delinquency. High levels of lead poisoning can cause severe cognitive disabilities, coma, or death. Medical treatment can reduce the amount lead in a child’s body, but the damage is irreversible.

Direct Indicators: In 2007, there were 46, 355 children ages 5 and under residing in Baltimore. However, only 18,363 children, ages 0 to 6 years, were tested for lead exposure in 2006. There is a huge gap of children not being tested.  In 2006, 4.6% (843 children) of these children tested positive for lead poisoning. Comparatively, in the entire state of Maryland, the rate of children testing positive for lead poisoning is 0.5%. Relatively, Baltimore still has pretty high rates of childhood lead poisoning.

The main weakness of these statistics is the fact that there is a huge gap of children not being tested. For all we know, the rate can be a lot higher than what is being observed. Even with the mandate, there seems to either be not much compliance or simply no access physically to healthcare for a child to be tested. But, I do believe it's accurate just because it’s not self-reported- it’s mainly through clinics and providers. Also, the evidence of whether or not a child is poisoned by lead is rather concrete with very little room for false results.

Indirect Indicators: . Baltimore claims one of the highest crime rates of cities across America, ranking number 5 for the murder rate. The graduation rate in the city is 62.7% with 45.8% of students graduating on time. 18.1% of children in grades 6-8 are in special education. 43.9% of students with disabilities, of the ages 6-21, are in the less than 21% least restrictive environment. There are 10.1% of children with disabilities age 3-21 with mental retardation, as compared to the 5.3% in Maryland. About 20% of residents in Baltimore live with incomes below the poverty line. 9.4% of residents live with incomes below 50% of the poverty line.

To see these indirect indicators as such, your perspective on the implications of lead poisoning have to follow reality. In other words, you have to believe that lead poisoning is, a root cause of high crime rates academic failure, and mental disabilities in a city. Of course, many arguments can be made against this claim, but it’s pretty hard to deny that lead poisoning is indeed a root cause of many. Again, the strengths of these statistics are that they are reported from the city, so they are presumed to be rather accurate.

Sources

Baltimore City Data Collaborative - Information on Children and Families in Baltimore, Maryland. Web. 24 Oct. 2010. <http://baltimorekidsdata.org/>.

"Baltimore City Health Department Lead Poisoning Prevention Program." Baltimore City Health Department. Web. 20 Oct. 2010. <http://www.baltimorehealth.org/lead.html>.

"Baltimore City QuickFacts from the US Census Bureau." State and County QuickFacts. Web. 01 Nov. 2010. <http://quickfacts.census.gov/qfd/states/24/24510.html>.

Fenton, Justin, and Peter Hermann. "FBI Releases 2009 Crime Stats; Baltimore No. 5 for Murder Rate." Baltimore Sun 24 May 2010. Print.

"Lead Exposure In Children Affects Brain And Behavior." American Academy of Child & Adolescent Psychiatry. Web. 30 Oct. 2010. <http://www.aacap.org/cs/root/facts_for_families/lead_exposure_in_children_affects_brain_and_behavior>.

"Lead Poisoning- Children." The Coalition to End Childhood Lead Poisoning. Web. 31 Oct. 2010. <http://www.leadsafe.org/index.cfm>.

Blog #10: Final Paper Topic

I am still debating whether or not I want to write about this topic, but I am looking to write about Childhood Lead Poisoning in the city of Baltimore or Washington, DC. My paper would address either is prevalence among those in low income areas, in general, or just about homeowners who are not under the Maryland Lead Law. So, basically in Baltimore, there are still about 5% of children testing positive for lead poisoning. In Maryland, the rate is about 0.5%. Also, in Baltimore, there is a huge gap in the number of children being tested. The blood lead level of concern now is for lead poisoning is 10 mL/g. But there is no safe level of lead. Lead poisoning has its greatest impact on children aged 6 years old and younger. They are exposed through lead paint and dust in homes, drinking water, soil, toys, among many other common areas.
This problem is very important because lead poisoning causes many implications. Lead is a neurotoxin and carcinogen. It causes brain damage, mental health issues, violent behavior, academic failure, and many other problems. Because of these hazardous effects, it makes it rather difficult for children to focus and behave and makes them anti-social and violent. This problem is very relevant to Baltimore and Washington, DC because even though this problem has been helped tremendously, these areas still have a widespread prevalence of lead poisoning.
This problem is of interest to me because I've done a lot of research on it and I genuinely love children! I feel like every child should be able to reach their fullest potential. Lead is 100% preventable, but in no way curable! This is not a significantly difficult problem for it to still be causing so much damage in these areas. Lead poisoning has societal implications and  vigorous efforts should be made to address this issue.

-Thomasina :)

PH Blog #9: Reflection...

First, I would like to say I am very glad to have taken this class. It has confirmed my desire to go into Public Health as a career and learn more about it. In the first 'half' of class, I have learned a tremendous amount of information. Topics that I have found rather interesting are chronic diseases, advocacy, health care reform, and obesity. Chronic diseases basically hit home for me. It is one thing to know that some lifestyle behaviors are unhealthy, but another to be faced with the reality of the consequences. With a diabetic mother and a father with heart problems, that reality was almost amplified when I thought about my future and what it would be like if I didn't make lifestyle changes starting now. This lecture prompted me to go see a nutritionist and actually start incorporating exercise into my daily life- and it has been working pretty well for me! With limited income at home since my mother is the only one working, money has always been an issue when it comes to resources such as a nutritionist or a gym- but now that I am here, I have no excuse. So, I'm glad that the lecture basically changed my life.

Advocacy and health care reform fall hand in hand in my perspective. I pretty much loved these lectures because I'm all for healthcare reform and I love when people advocate and teach others to do so, because that's what I'm all about as well- informing people and lending a hand for them to jump on the bandwagon for health care reform!

The obesity lecture was just another one to remind me of the reality of living an unhealthy life. This lecture was almost like a booster to remind me to keep up the changes and realizing that in the end it will all be worth it- for me and my family to come. I also liked it because of the answer or aspect that was given to the answer of why obesity was becoming an epidemic. It was something I've thought about, and it was interesting to hear it thought out by someone else. I also like the way that lecture was presented- very interesting and almost entertaining! Loved it.

I really didn't find anything too surprising. But I have definitely undermined the role of epidemiology in public health, but after reading and hearing about it, I learned that it is actually very necessary and quite helpful. It acts as a support for public health and I'm glad that I see it that way now.

Nothing has really changed since that blog. Like I said earlier, if anything, it’s that this class, well the first 'half' has definitely confirmed my desire of going into public health. I loved the readings in the textbook and have made my decision to keep it- just because it’s such an easy read and presented rather well compared to some textbooks- it wasn't boring. Nevertheless, I still do plan on going into Health Policy, less of the management side. Definitely up for advocacy as well. I'm glad I took this class. I definitely do see the need for public health to continue and expand in our nation and in the world! There is a need for the emphasis on medicine to decrease and the emphasis on public health to increase- and I have seen that it is a necessary measure to be taken to even begin to combat the issues we are facing today.

Until next wwek,

Thomasina

Blog #8: Quarantine/Isolation- Whose right and whose wrong?

The case I will discuss in today's blog is: Decision of the Supreme Court of South Carolina in the case of KIRK v. WYMAN. Quarantine is for those who have been exposed to an infectious disease, but they may or may not become ill. Isolation is for those who are known to be ill with a contagious disease. So, the difference between isolation and quarantine is the knowledge of whether or not you are infected after the exposure.
I definitely think that state health departments should make the decision as to whether someone should be quarantined. I also believe that the guidelines set for this decision should be agreed upon and made known to the public, and when it comes down to the decision, that it be made in honest judgement and meet every provision and requirement of the already set guidelines. As seen in this case, it became quite a sticky situation, especially since Mrs. Kirk believed and was given an opinion from a specialist in London that her form of leprosy was not contagious. Therefore, I think it should be necesary that the public is informed of the guidelines for quarantines. I also think that it should be stated somewhere that outside opinion is invalidated when you are in the city or state because it can never be clearly known if the opinion recieved from an outside source is valid.
Again, I truly do believe that the state should be held responsible for balance the right of the individual versus the right of the community. I believe that it is more appropriate to err to the side of protecting the rights of the community, but not to the extent that the individual is demoralized or humiliated in any way. I feel like, especially when it comes to contagious diseases, that the community at large should be widely protected, only because if it does spread, it only ends up putting more people in danger and can greatly impact the community in a dangerous way. Like the compromises made for Mrs. Kirk for the place she was staying in, I think that should definitely be instituted when relocating an exposed individual. Even thought it is rather inconvenient to her, it should be made to be understood that its for the protection of the community. This, however is a really sticky situation, but I do believe that the power resides with the states to make these decisions, come up with guidelines to be followed, and inform the public.

-Thomasina

Blog #7: Global Health...Spreading health through wealth!

The article I will be discussing today is: The Challenge of Global Health. This article elaborately details the many aspects and factor that play into the success and failures of global health initiatives. It analyzes problems that arise on behalf of the donors, explains the current conditions of these nations, primarily those in sub- Saharan Africa, and illustrates optimal conditions needed for successful initiatives. The article begins by stating the various amounts of rather huge donations given to improve global health. The writer explains how much money is being given but for narrowing targets that hinder progress. The writer also explains many countries are short in health care workers because many, once trained emigrate to wealthier nations through recruitment or seeking a better life; and hold wealthier nations accountable for making situations in these countries worse because of their frequent recruitments. The article goes into much detail about where the money is coming from- whether it be philanthropic work (a significant amount from the Bill and Melinda Gates Foundation), PEPFAR (provided by the Bush administration), individuals, among many other sources.

It also explains how much of this money comes with strings attached and narrow purposes, making it very hard for change to occur. The article then goes on to explain problems with the funds actually being spent appropriately with estimation that about "half of all the funds donated for health efforts in sub-Saharan Africa never reach the clinics and hospitals." The article continues to analyze all these different problems hindering success, but most importantly, near the end, it states the correlation between maternal health and life expectancy and global health. It explains the optimal conditions required for acceptable global health and how donors should broaden their perspectives and be held accountable for the money they supply, and how these are practical solutions for better global health.

The reasons that I see are most valid for the worsening of public health globally in the developing world is definitely the lack of a health force base in these nations as well as the narrow targets of donors. I see these reasons as the leading causes of this worsening because as the article states briefly, you can help a nation as much as you want, but if they can't stand on their own after you leave, then you have actually done them a disservice. The lack of a healthcare force is a hindering factor also in that with all the money supplied, it’s almost like a lot of it has no receiving end and almost like its being thrown in the air for whoever is around to catch- good or not. The narrow targets of donors greatly inhibits progress because though HIV/Aids is a major issue, it’s only a symptom of the lack of funding when it comes to family planning and maternal health- this is the major issue. The narrow targets almost act like a teaser or a deceiver. Yes, a lot of money is being put in to help, but its helping the wrong things and is yielding no progress.

The two markers considered the most important indicators of the status of health care systems in developing countries are maternal health and overall life expectancy. Maternal health is an important marker because "pregnant women survive where safe, clean, round-the-clock surgical facilities are staffed with well trained personnel and supplied with ample sterile equipment and antibiotics"- all characteristics of a general good facility, and what better place to have that than when life is born. Life expectancy is also an important marker because if children can survive passed their 5th birthday in optimal conditions such as safe drinking water, available immunizations, nutritional food, etc. If any of these factors are absent, many do perish- causing low life expectancy.

Two examples of diseases that extend from faulty systems and the lack of sustainability of current donor practices which led to more deadly diseased states than what was first initially encountered are malaria and HIV/Aids. The current donor system contributes to malaria by most of the time increasing the quantity of bed nets handed to children to block disease carrying mosquitoes. The current donor system contributes to HIV/Aids by usually increasing the number of people receiving necessary drugs. The aid in these cases is both "tied to short term numerical targets" rather than addressing the issue of public health itself.

In such a big world, how can you make a difference?

Until next time,

Thomasina

Blog #6: Beware....Whooping Cough Ressurected!

The article I will be discussing today is entitled: Whooping cough makes a comeback; found in The Washington Post. This article talks about the resurgence of whooping cough in California, especially among young infants. Few babies have died, while hundreds have become 'desperately ill.' The article then goes on to discuss the possible factors that may contribute to the resurrection of this horrible illness. Some factors include it being easy for parents to opt out of vaccinations for their children in California; pertussis is more infectious than other diseases and spreads quickly among those unprotected; and even problems with the current vaccine- it being acellular, rather than a whole-cell vaccine. Nevertheless, vaccines did help get rid of whooping cough for some time, even causing some to believe it was no longer in existence. But, the article still cautions parents to make sure their kids are indeed vaccinated, followed up with booster shots as necessary, even in adulthood, to extinguish this spreading and deadly disease.

Herd-immunity is the idea that if most or a good number of people are vaccinated, even those who are not vaccinated are protected as well because it becomes harder for a virus, bacteria, or what have you, to find a vulnerable and susceptible host. This relates to public health's importance of vaccinations in that the idea of 'herd-immunity' becomes a problem if more people are opting out of vaccines because of it, making it easier for infectious diseases to spread. Herd-immunity only stands true if most people are actually vaccinated; this idea becomes dangerous when parents think their children are ok because the other children are vaccinated, but other parents are probably thing the same thing.

There are many reasons why children don't receive the recommended immunizations. Two that originate from patients/parents are the idea that herd-immunity stands true in their community and some parents are afraid of side effects from the vaccine- such as the mistaken association that the measles vaccine causes autism in children, or real side effects such as fevers and seizures. Two that originate from physicians are that the now commonly used acellular vaccines are not as good as the whole-cell vaccines and that without boosters, vaccines may become ineffective. Two that originate from the healthcare system are that vaccine production and availability is decreasing and that vaccines don't seem to be mandatory in some areas.

In dealing with the recent resurgence of whooping cough, it would be a priority for all young children, students, and parents and other adults working with children or students to receive the vaccination or a booster to create the ideal state conducive for herd-immunity so that those who may not have access are also protected. I also think it would be necessary to immediately put into effect mandatory immunizations required before entering school- public, private, or home-schooled. This would prevent any other resurgence in the future.

Some food for thought.

Later,

Thomasina