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Thursday, August 27, 2015

So, you think you know public health? (A health inequity primer)

People tend to be very uncomfortable talking about race, ethnicity, gender, sex or poverty. 

That’s a shame. 

These issues are inextricably tied to most of society’s problems, yet very few people can communicate properly around them – let alone take real action. 

This is a major roadblock for those working to improve the public’s health. Nearly every county health officer that Brown·Miller Communications has interviewed for our ongoing Health Officers Communications Project identifies inequity as a major health threat. But what does that mean in the context of health?

Health inequities are systemic differences in health outcomes that spring from unfair social conditions or disparities in the distribution of resources. For example, low-income families are more likely to live near polluters that increase the risk for asthma. African-Americans are more likely to see tobacco advertisements, start smoking and develop lung cancer. Women are more likely to be victims of domestic violence.

All of these adverse health outcomes are the result of social problems and, in general, not personal behavior, genetics or happenstance. Yet many in the health arena focus on fixing the aftermath of these outcomes, instead of the basic inputs that are overwhelmingly preventable. 

In other words, our obsession with health care reform and pharmaceuticals has distracted us from the real roots of our problems.

Low-cost policies and programs that decrease pollution in low-income areas can prevent high-cost asthma. Controls on tobacco marketing can prevent young African-Americans from becoming addicted. Changes in social norms, through public relations campaigns, education and organizing, can prevent domestic violence. 

Prevention is key. 

But for prevention to be successful, health leaders must work with every other sector of society to push for social changes that influence public health.

That means county health officers must work with other county departments (housing, economic development, human services, etc.) to address the social determinants of health. They also must communicate better with community organizations, advocacy groups and stakeholders to coordinate their work for maximum impact. We’re working with all of them to help make this happen.

But you, dear reader, can also help turn the tide against health inequities by changing the way you think and the way your organization works, thus helping shape society’s norms.

Here are a few steps:

1. Recognize your privilege. Bear with me – I’m not trying to be “politically correct.” But I am going to be frank. Every person is born into their own unique situation that frames their behavior, interacts with other’s preconceptions and guides their path in life. Some situations make it easier to be healthy and successful. If you’re born to two white parents, in a wealthy neighborhood, you’re much less likely than the average person to have heart disease when you’re fifty. But if you were born a black foster child, in a low-income neighborhood, you’re much more likely to take up smoking (because of intense marketing at the local convenience store), eat fast food (because that’s your only option) and gain weight (because the city never invested in public parks in your community). Then, you will probably develop heart disease by your fiftieth birthday.

Life is like a marathon. But in this marathon, some people begin at the starting line, while others begin one step from the finish line. Addressing health inequity requires us all to ask a critical question: where did I start my marathon? 

2. Communicate and act in a manner that recognizes oppression and counters it. It is important to recognize when something you say or do perpetuates inequity.  Don’t stumble into prejudicial behavior like assuming certain groups “don’t show up” or “don’t fit in,” or that going into a particular community is a “safety concern.” Don’t assume certain groups are being hypersensitive when they react to your actions. From their perspective, you may have inadvertently participated in an injustice. Don’t dilute action by focusing on “helping everyone” when certain groups have greater needs and we only have a limited capacity for action. 

3. Change business as usual. Create a “new normal” by openly challenging oppression when you see it. This can be done by working with community organizations to call for change, putting pressure on elected officials and business leaders, or reforming your own organization from the inside. The key is to open up lines of communication between as many groups as possible to build community capacity.

I have only touched the tip of the iceberg in this primer. If you want to dive even deeper into the subject of health inequity, the National Association of County and City Health Officials (NACCHO) offers a free online course on the subject called “Roots of Health Inequity.” It’s highly interactive and very informative. I strongly recommend it.


Monday, August 17, 2015

Warning! Don't Be Fooled By Industry Purchased "Science"

With soda sales declining and legitimate studies linking consumption of sugary drinks to obesity, diabetes and other chronic diseases, it was only a matter of time before Coca-Cola came up with a “new” old strategy to counter criticism and boost lagging sales.

This week Coca-Cola admitted it was funding the not-for-profit Global Energy Balance Network, the GEBN. Who comes up with these names? 

GEBN “so-called scientists” are claiming that the science linking sugary drinks to obesity is inconclusive and that losing weight is all about exercise, not diet.

We’ve heard this before. Remember the “it’s the couch, not the can” campaign that claimed there is nothing wrong with sugary drinks as part of a healthy diet? Well, it is back in the guise of GEBN. 

But people aren’t stupid, and the ploy, which is reminiscent of Big Tobacco’s efforts to cast doubt on the dangers of smoking, is backfiring. Since the announcement this past week, critical editorials and articles quickly appeared in a slew of influential publications, including the New York Times, Washington Post, Sacramento Bee and London Guardian.

In their editorial, “Coke Tries to Sugarcoat the Truth on Calories,” the New York Times discusses some of the soft drink industry’s shady tactics: paying dietitians to write blog posts or articles suggesting that a mini-can of Coke would make a good snack food, deploying armies of high-priced lobbyists to fight against soda taxes, soda warning labels and financing scientists to support industry claims.

Exercise is important, but if you want to weigh less, the best exercise is to push yourself away from the table and drink plain water, not sugar water.

Thursday, August 6, 2015

Can today’s newspaper predict obesity rates in 2018?

New research reveals it may be possible to estimate a nation’s future obesity prevalence based on how frequently national media mentions sweet snacks and vegetables or fruits. In “FiftyYears of Fat: News Coverage of Trends That Predate Obesity Prevalence,” researchers tracked mentions of healthy food items and less healthy food items over the last 50 years in the New York Times and the last 17 years in the London Times and then compared with obesity data. The findings reveal that obesity rates increased when newspapers featured more unhealthy foods than healthy foods.

 “Mentioning more sweet snacks and fewer fruits and vegetables over the past fifty years has influenced rather than reflected an increase in unhealthy consumption, which would subsequently increase obesity,” said Brennan Davis, the study’s lead author. 

The study highlights how important media can be for public health officials in improving health behaviors. Public health officials should have good working relationships with their local media and encourage reporting that promotes healthy behaviors, such as news articles about the impact of diet on health, sharing recipes for healthy foods and promoting restaurants with healthy offerings. Also, tracking media coverage of healthy foods and less healthy foods can help health educators get a pulse on the effectiveness of current obesity interventions. This in turn could help them adjust public health messages and interventions.

Friday, July 31, 2015

The Sandwich We’re Not Talking About

This sandwich consumes 10 percent of California’s prime 40 and up career-minded men, but mostly women. They can’t stop thinking about it. Some have even given up their jobs for it. What sandwich can this be? Maybe it’s a hipster concoction of a pastrami burger on a brioche bun dripping with avocado aioli and homemade ketchup – or something like that.

Unfortunately, I’m talking about the growing number of adults, nearly two million Californians, who are taking care of both their children and aging parents. These “caregivers” are called the sandwich generation. So much for that delicious bite. According to the University of California, Berkeley, report, the facts are sobering. With more than 80 percent of long-term care still provided by family and friends without compensation, the sandwich generation is feeling the squeeze. Let me give you some key ingredients from that go into this “sandwich”:

  • Typical sandwich generation caregiver in California:
    • Middle-aged woman (average age 39)
    • Well-educated, having obtained at least some college education
    • Employed full-time
    • Income is below the California median
  • 93 percent of caregivers are not paid for the time spent providing care.
  • 27 percent of caregivers in the U.S. reported a high degree of financial hardship from caregiving.
  • Sandwiched caregivers in California more frequently report not being able to afford to eat balanced meals and hungry due to lack of money.
  • Nearly half (47 percent) of California voters who are likely to need paid long-term care service in the next five years say they will not be able to afford one month of care, and the majority (75 percent) report they cannot afford more than three months of nursing home care.
  • Caregivers are more likely to experience physical strain, emotional stress and financial hardship.
  • Family caregiving in California was estimated at $47 billion in 2009, far exceeding the $12.8 billion in Medicaid spending for long-term care in the same year.

These bites are hard to swallow. California’s elderly population is growing, and rising health care costs are contributing to the increased demands of informal caregivers, but quite frankly, the menu options are extremely limited. As we move into the baby boomers’ silver age in the next decade, will California have more options, or are we doomed to have sandwiches for breakfast, lunch and dinner?

Jack Ohman draws his experience of caring for his dad in his editorial (click on the link for the full story):

For more in-depth look at UC Berkeley sandwich generation report, go to

Friday, July 17, 2015

East Bay Regional Parks . . . Natural Treasures in Our Own Backyard

Are you looking for something to do? Well, if you are, I would like to suggest you visit any one of the 65 parks within the East Bay Regional Park District. You'll find a multitude of beautiful and interesting places to explore.

Here's a little background on the East Bay Regional Park District: The citizens of Alameda County voted to establish the park district in 1934. During the height of the Depression, they were willing to tax themselves to set aside open land for public use. Tilden, Sibley Volcanic Regional Preserve and Lake Temescal were the first three parks. In 1964, most of Contra Costa County came under the Park District's purview. Currently, the park system encompasses an impressive 119,000 acres of land with 1,250 miles of trails, making it the largest regional park system in the country.

To learn more about the East Bay Regional Park District, check out their website at The motto on their home page says it all: Healthy Parks Healthy People.

And if you would like to volunteer your time, the East Bay Regional Park District has many options open to you. I recently joined their Ambassador Program and last Saturday volunteered my time at the Black Diamond Mines Open House in Antioch. It was such a pleasure to see how much everyone, young and old alike, enjoyed their tour of the mines.

So get out there and take advantage of the bounty we have available to us in our own backyard.


Wednesday, July 8, 2015

Is it time to take up underwater basket weaving? (Or how we all may be unemployed soon, and that’s okay.)

Like jokes? Here’s one you might enjoy.

So, a robot reporter, a digital cashier and an automated driver walk into a bar. They turn to the bartender and say… 


Because they aren’t people. Also, the bartender is non-sentient and nothing ever happens at all.

The end.

Well, maybe that’s not your sense of humor. 

Or, we might just have a major problem (or opportunity) coming around the corner.

Throughout history, there has only been one characteristic of our economy that remains a constant: its inconstancy. We began as an agricultural society and slowly transformed into an industrial society. Then, America began to outsource these jobs and grow into a service-based economy. 

Today, about 15 million Americans are waiters, cashiers, reporters or drivers. This won’t last long.

McDonald’s and Panera Bread have recently introduced self-service kiosks. Applebee’s and Chili’s have followed suit and now provide ordering tablets that limit our interaction with human waiters. These workers have now been relegated to the position of glorified busboys. 

Google has almost perfected automated driving. Soon Uber will be able to end its labor woes and shift to a robotic work force. Back in May, the state of Nevada issued its first commercial driver’s license to an automated truck.

IBM’s Watson has continued to advance following its dramatic victory on the Jeopardy game show. Today it can create custom recipes that even the most talented chefs have yet to dream up – all for free. 

And the piece de resistance? The Associated Press, the nation’s news leader, has begun outsourcing its financial and sports reporting to an algorithm produced by Automated Insights. Wordsmith, as it is called, now produces 3,750 articles each quarter.

That’s today’s state of affairs. Now imagine where we will be in fifty years. Once service jobs are fully automated, industry is made more efficient and software comes closer to artificial intelligence, what will be left for humans to do?

Well, for one, underwater basket weaving is an option -- if that is your sort of thing. 

That may not be the best choice though. Let me elaborate.

If the majority of jobs in 2065 are obsolete – assuming no unprecedented natural disasters or unimaginable economic transformations – Americans will have a lot more free time on their hands.

Yes, there will always be a need for certain professions that require a human touch or significant human oversight. But as technology advances, the number of jobs in that category will dwindle. At some point in the not so distant future, unemployment may rise as high as 80 percent. The only people powering the economy would be the ones programming and maintaining the machines, or working as a lawyer, doctor or celebrity. 

In that case, society will have to transform to cope with this new reality. We’ll have an intriguing spectrum of options and probably the greatest political fight of a generation. We will need to choose to:

1) Create a guaranteed federal income and allow Americans to pursue any personal passion project. Want to go paint a masterpiece or write a sonnet? Go ahead. Prefer to sit on the couch and watch Netflix? More power to you! This may lead to a new creative renaissance as barriers are lifted from participation in the arts. Or, more likely, we’ll all grow even larger as a people because of chronic inactivity.

2) Launch the first marketplace for social goods and tie participation – and success – to income. This is the more realistic and socially advantageous option.  In 2015, many jobs that need to be done aren’t done because of market inefficiencies or insufficient tax revenue. We having aging bridges, limited mass transit and chronic droughts. Free time and guaranteed income – in exchange for a shorter work week of public works – could help solve many of these major infrastructure problems. Our current economy also fails to cover many less tangible goods like cultural programs, public health campaigns, early childhood education, senior care and hundreds of other needs that fall through the cracks due to limited funding within the nonprofit realm. Many of these needs could be fulfilled with labor provided by those with free time. 

For example, governments could create an easily accessible database that list social projects and connects project managers with those interested in their projects. People could move around from project to project and accumulate points to earn their income. Soon enough people could be working together to make the world a better place.

3) Keep the status quo with a traditional economy. This would be the least optimal situation in this hypothetical future. Without most jobs, inequality would skyrocket and the economy would become highly unstable. In theory, we could shift to an extremely short work week in exchange for higher incomes, but that would not necessarily be possible. It’s hard to predict how much of the remaining economy could be diced up and shared to ensure a functional distribution of resources.

What will the future hold? I guess we’ll have to wait and see. In the meantime, I suggest going back to school and majoring in underwater basket weaving. It’s better to be safe than sorry. 

~ Jonathan

Note: You can explore this hypothetical world more with in-depth analyses by the Atlantic’s Derek Thompson or the economists at Planet Money.

Thursday, June 11, 2015

BMC applauded for best public service campaign in 2015

We wanted to share some good news... at the Public Relations Society of America (PRSA) awards ceremony in New York last week, Brown·Miller Communications won the nation’s highest award for public relations, the Silver Anvil, for public service campaign.
And while that’s all pretty cool, what’s really exciting is that we won for the work we did with the California Center for Public Health Advocacy on Sugary Drink Warning Labels.
You have to appreciate that PRSA is a VERY pro-business organization. For them to bestow this on a program that attacks Coke, Pepsi, Dr. Pepper, Gatorade and other major beverages is a sea change and a real indication that, as Bob Dylan said, “The times, they are a-changin.” For that, kudos to all of our colleagues and friends who have played a role in changing community norms around sugary drinks –we all know it’s a long battle, and this is just one more indication that your work is having an impact.