Suicide prevention gets a new partner: Facebook

If you or anyone you know is having thoughts of self-harm, please reach out to organizations like the National Suicide Prevention Hotline or call their hotline directly at 1-800-273-TALK (8255). If you or someone you know is in immediate danger of self-harm, call 911 immediately. Your life is worth living and you don’t deserve to suffer.

Generally, my Facebook newsfeed is filled with silly photos of people waiting for the subway, declarations of love for a person’s partner, and snarky comments about current events. Sometimes, however, I see comments that make me concerned about someone’s mental health. I’ve been fortunate not to have seen anything that I felt needed to be reported, but I know that’s not the case for everyone.

Facebook announced yesterday that they are partnering with Forefront, Now Matters Now, the National Suicide Prevention Hotline,, and other mental health organizations to create a more effective reporting program for people whose friends are expressing suicidal thoughts on Facebook.

When someone sees a friend's (let's call him Gerald) troubling post, they will have the option to report it directly to Facebook. Right now, at the upper right hand corner of every post, there’s a little downward arrow that, when you click on it, allows you to choose the option to report the post for potential suicidal content. (I haven’t been able to find screenshots of what that screen will look like, and the capability has not yet been activated on my account so I couldn’t make any of my own.)

The post will then be reviewed by “teams working around the world” to determine if the post does in fact imply that Gerald is in danger of self harming. If so, the next time Gerald logs into his account, he'll see this:

Facebook suicide prevention screen 1facebook_suicide_prevention_2facebook_suicide_prevention_3 Source: Huffington Post

One of the things that seems most promising is that Gerald doesn’t seem to have the option to dismiss these screens. He will have to at least click through the resources in order to get to their newsfeed. Hopefully, this will help reach some people who need help but aren’t able--for whatever reason--to ask for it or recieve it.

I also hope that Facebook is planning to critically evaluate this change. There are lots of unintended consequences that could arise from this new reporting system: a drop in posts containing potentially suicidal content, quick click-through speeds that imply users aren’t actually reading the resources, and gross misuse of the capability that floods the reviewing teams, making effective review difficult or impossible.

And when Facebook evaluates the initiative, I hope they make that information public. Because social media can provide a platform for mental health intervention, we need to know if a huge intervention like this is actually successful.

To learn more about this Facebook change, check out the Facebook Safety post explaining what’s happening.

Did you forget about Ebola?

Ebola Ebola was big news in 2014. But we seem to have lost interest in it, especially now that no one in the US is being treated for the virus. While the number of cases in African countries is dropping, the epidemic and its repercussions are far from over. In fact, there are still important developments happening every day.

A promising new treatment An experimental antiviral drug has shown potential for treating early cases of Ebola. Favipiravir, which has also shown to be effective against influenza, West Nile, and yellow fever as well as other viruses, seems to drastically reduce mortality in patients who are not yet seriously ill. It doesn’t seem to help patients with severe Ebola infection. One of the most important advantages of favipiravir is that it is a pill. Other potential therapies must be kept frozen and are administered through infusion, leaving the health care worker at risk for needle sticks.

Red Cross aid workers suffer from attacks in Guinea In Guinea, public misconceptions about the role of aid workers and the mode of Ebola transmission have led to attacks on Red Cross and other volunteers conducting safe burials of deceased Ebola patients. While many Guineans understand and accept the practices the Red Cross uses to disinfect homes and bury Ebola victims, some are concerned that the Red Cross is actually spreading the virus. This has resulted in an average of 10 attacks per month. The Red Cross is warning that the violence against its volunteers is hampering its ability to contain and quell the epidemic.

Maybe Ebola can be transmitted through aerosols, but probably not One of the best things about this 28 day writing challenge is that through my research I found Carl Zimmer. I aspire to his level of health writing clarity and scientific rigour. His piece “Is It Worth Imagining Airborne Ebola?” does an excellent job of outlining the concerns expressed by a few scientists while also offering the counterpoints that help give those concerns context. Before you get carried away with alarmist headlines, take a look at what he has to say.

From soap and water to soap opera Sierra Leone is starting to move from the traditional forms of public health communication to a more innovative medium. Celebrities are partnering with a major bank to create a soap opera designed to help prevent transmission, explain treatment and safe burial practices, and dispelling myths about Ebola. One of the twelve episodes focuses on quarantine by centering around a family who is under quarantine. Through this storyline, the actors explain what happens during a quarantine and why adherence to it is crucial. In the major city of Freetown, the soap opera is broadcast on television, while in more rural areas, it plays on the radio.

Right now, the Ebola epidemic seems to be waning. However, this epidemic will resonate throughout the region for decades. Even as new public health issues surface, we would be well-served to remember what has and is happening in this part of Africa.

Raw milk, cholera, and Appalachia: Cool stuff I read this week

I came across a bunch of interesting articles and bits of news this week, and I thought I’d share them with you. Spend your lazy Sunday catching up on current events. The Dietary Guidelines Advisory Committee released its recommendations this week. They encourage us to eat less sugar and saturated fat, but say we don’t really need to worry about our cholesterol intake.

There’s a new rapid test for Ebola.

Speaking of Ebola, Al Jazeera America ran a fascinating and discouraging two-part series on the social implications of the epidemic.

Although Haiti has improved its infrastructure in response to the epidemic, cholera is still a major problem in the country.

This interview with the Baltimore City health commissioner Dr. Leana Wen reminds us that public health isn’t just about Ebola and cholera and measles--it’s also about rat control and the social determinants of health. [Audio and abridged transcript.]

Flu season is starting to wind down.

The first broad study of two kinds of muscular dystrophy was published, revealing important epidemiological information about the disorders.

Despite some progress, Appalachia is still teeming with health disparities and poverty.

There’s a new tickborne virus in town.

For goodness’ sake, stop drinking raw milk. Pasteurization exists for a reason!

More than 25% of Americans with diabetes are undiagnosed. That’s 8.1 million diabetics who are not receiving treatment or making lifestyle changes.

Thank you, Alan Cumming, for using humor to highlight just how ridiculous the FDA’s new ruling restricting gay and bisexual men from donating blood unless they have been celibate for a year.

Alan Cumming Celibacy Challenge


Come back tomorrow for another Awesome Infographic!

John A. Rich: Black men, trauma, and nonviolence

Now that I’m out of grad school and back in the workforce, I can appreciate the unique public health perspective that Drexel’s School of Public Health imparts upon its students. Other schools don’t focus as heavily on health disparities, trauma, and adverse childhood experiences. One of the reasons these issues are at the center of Drexel’s philosophy is because of the presence of the Center for Nonviolence and Social Justice, headed by John A. Rich, MD, MPH. John Rich, director of the Center for Nonviolence and Social Justice

Dr. Rich grew up in a middle-class home--his mother was a teacher and his father was a dentist. After completing his undergraduate degree at Dartmouth and earning his MD at Duke, he became an emergency room doctor at Boston City Hospital.

While at Boston City Hospital, Rich saw a steady stream of young Black men come through the emergency room with stabbing and gunshot wounds. He also began to realize that everyone, including the other medical staff, saw these men as perpetrators rather than victims. The general consensus was that these men had done something to get themselves injured instead of what was obvious to Rich: these young Black men were truly victims.

Because of his compassionate streak, Rich began interviewing these men to learn more about their lives and what led to them returning to the ER over and over. He learned that the injuries that brought them to him were often due events outside their control--a robbery, a few wrong words to the wrong person, a simple accident that escalated to violence. After talking with them as they received treatment, Rich realized that the men were suffering from post-traumatic stress syndrome. Even worse, their injuries were stitched up and they were sent right back out to the same environment that brought them to the ER.

Rich wrote a book about these experiences called Wrong Place, Wrong Time: Trauma and Violence in the Lives of Young Black Men. I read this book as part of a class I took with Sandra Bloom (who works closely with Rich). Reading it was easily the most emotionally moving and motivating activity I participated in at Drexel.

In 2006, Rich was awarded a MacArthur Fellowship for his work:

John Rich is a physician, scholar, and a leader in addressing the health care needs of one of the nation’s most ignored and underserved populations—African-American men in urban settings. By linking economic health, mental health, and educational and employment opportunities to physical well-being, Rich’s work on black men’s health is influencing policy discussions and health practice throughout the United States...By focusing on the realities of the lives of young African-American men, John Rich designs new models of health care that stretch across the boundaries of public health, education, social service, and justice systems to engage young men in caring for themselves and their peers.

Now, Rich is a professor and head of the Health Management and Policy department at Drexel University School of Public Health. He is also the director and founder of the Center for Nonviolence and Social Justice, a non-profit dedicated to applying principles of non-violence and trauma-informed care to public health practice and evaluating the results of the programs that embody those values.

While I was completing my MPH, I unfortunately did not work with Rich--in fact I'm not sure I ever even met him. However, I had the good fortune of having Dr. Jonathan Purtle, who worked closely with him and others at the Center, as my academic advisor. Honestly: reading Rich’s book and working closely with his colleagues changed the way I understand public health, and, frankly, myself and the world around me.

John Rich has changed the way we understand urban Black men’s health. As the gospel of trauma-informed care spreads throughout public health, medicine, and public policy, I hope we will see a more compassionate view of Black men radiate throughout these institutions. We know that what we’ve been doing for these men hasn’t been working--and John Rich has shown us how to make changes that will actually help.

Awesome Infographic: The Secret Life of Water

Infographic describing clean water and water sanitation problems worldwide This great infographic put together by Mairi McKay, George Webster, and Matt Baringer of CNN uses data from UNWater to illustrate important facts about drinking water around the world. Some of the stats:

  • 80% of illnesses in the developing world are related to water.
  • 1 in 4 urban residents worldwide do not have access to clean water--only 11% of city dwellers in Uganda can safely consume the water.
  • While nowhere near comparable to what’s happening in the developing world, it’s surprising to see that 3% of Americans living in cities do not have access to safe water.

As water shortages continue and inevitably worsen, these problems will only be exacerbated. Learn more about the issues and proposed solutions from UNWater,, and the WHO.

TissuGlu, measles, and herbs: Cool stuff I read this week

Source. I came across a bunch of interesting articles and bits of news this week, and I thought I’d share them with you. Spend your lazy Sunday catching up on current events.

  • A father asks a California school district to require unvaccinated children to stay home in hopes that his son, whose leukemia is in remission and who cannot be vaccinated, will not be exposed to measles.
  • The names, addresses, social security numbers, and other personal information for up to 80 million Anthem health insurance customers has been accessed by hackers.
  • Prader-Willi Syndrome, one of the only known genetic causes of obesity, causes significant health problems. This piece in the New York Times Magazine highlights Rachelle, a young woman seeking treatment for the syndrome.
  • The BBC published a series of maps illustrating the growth of the Ebola outbreak within Africa and the presence of Ebola on other continents.
  • It’s about time the Americans with Disabilities Act is applied to websites.
  • The FDA has approved a new internal tissue adhesive called TissuGlu (what a creepy name) for use in surgeries removing excess fat or skin and for repairing separated abdominal muscles.
  • Lots and lots of Chinese kids wear glasses.
  • In store-brand herbal supplements, 4 out of 5 contained fillers like powdered rice and asparagus rather than the herbs named on the packaging.

Read up!

Vision Loss & Blindness: Neglected Public Health Problems

Eye chartPublic health tends to focus on a few big problems: obesity, cancer, smoking, vaccination. These are all crucial issues to address in order to improve population health in the United States. However, there are other health concerns that affect millions of Americans that don’t get the same attention but cause significant suffering. This week, driving back to Maryland, I listened to the new podcast Invisibilia. In the episode “How to Become Batman,” hosts Lulu Miller and Alix Spiegler talk with a man who, based on his own experience, argues that it is not blindness in itself that keeps blind people from being independent, but cultural expectations are to blame. Listening to this show, which I cannot recommend enough, I realized that I knew next to nothing about visual impairment and its public health impact. So, as is my M.O., I decided to find out!

What are the major sources of visual impairment and blindness in the United States? How prevalent are they?

  • Cataracts (20.5 million people). Despite the cost-effective and vision-restoring surgery available, cataracts are a major cause of blindness among African-Americans.
  • Diabetes-related retinopathy (5.3 million people). This is the leading cause of blindness among Americans age 20-74.
  • Glaucoma (2.2 million people). Glaucoma can be controlled if detected early. However, half of cases are not diagnosed and glaucoma is the leading cause of blindness in African-Americans.
  • Age-related macular degeneration (1.6 million people). In people over age 50, treatment with zinc and antioxidants have been shown to reduce risk and progression to advanced age-related macular degeneration.

What is the annual cost in the United States?

  • Direct and indirect costs equal $139 billion per year.
    • Direct costs such as medical care, vision aids/adaptations/devices, and direct care: $66.8 billion
    • Indirect costs such as productivity losses, long-term care, and entitlement programs: $72.2 billion
  • Disability-adjusted life years (DALYs): 283,000 DALYs per year; at $50,000 loss per year, this would add an additional $14 billion to the total cost per year.
  • Quality-adjusted life years (QALYs): 600,520 QALYs per year; at $50,000 loss per year, this would add an additional $30 billion to the total cost per year. (Learn more about DALYs and QALYs).
  • Total annual cost, including DALYs and QALYs: $183 billion

What can be done to prevent visual impairment and blindness?

  • Some problems, such as Leber congenital amaurosis and Stargardt disease, are due to alterations in the genome and therefore cannot yet be prevented.
  • However, about half of visual impairment and blindness could be prevented through early diagnosis and treatment.
  • The most important ways to avoid vision loss and blindness is to have regular eye exams and take proper precautions to avoid eye injury.

I had no idea so many Americans experience visual impairment or blindness. I plan to keep learning about these issues, and I encourage you to do the same. The links in this post lead to reputable sources of information and data. WHO has great resources about these issues on a global scale. And remember next time you find yourself bemoaning our inability to prevent cancer or teenage smoking—sometimes, a simple win like a trip to the eye doctor can be all a person needs to prevent debilitating vision loss.

What's coming up in February 2015

For the past two weeks, I've been doing a 30 day yoga challenge through the YouTube channel Yoga with Adriene. Not only is Adriene an adorably dorky and pleasant yoga instructor, but I've really enjoyed incorporating a daily practice. Maybe there's something about knowing that there's a new video waiting for me helps me get on the mat. Maybe it's Adriene's Find What Feels Good mantra. Whatever it is, I like it. I've been thinking a lot recently about how to balance my work (which includes regularly driving between Bethesda and Philadelphia), my personal projects like Action Phase and this blog, and having a semblance of a social life. My personal projects have taken a backseat to the big changes in my life--graduating, starting a fellowship, getting married.

But enough is enough! I'm making writing and podcasting a priority. I'm going to kick my butt into gear Adriene-style by writing on this blog every day from February 1 to February 28. It might be a short, simple thought of the day or a powerful infographic accompanied by some commentary, or a longer piece exploring an issue in depth. I'm excited about this 28 day challenge. I hope you'll join me!


Public Health Summer Reading List

One of my goals this summer—in addition to writing more, finding a beach I actually like, and keeping squirrels out of my garden—is to read as many books as I can. My first year of working toward my MPH is wrapping up, and while I learned a ton this year, I’m ready to choose which hundreds of pages I read each week. I asked for book suggestions from fellow students, Twitter connections, and friends. With the additional help of Goodreads, APHA’s Pinterest, and trusty Amazon, I compiled the list below. There were so many titles that intrigued me, I couldn’t narrow it down! I’ve already been reading When Prayer Fails, and The Purity Myth is next on the docket. You can look forward to reviews on each book as I finish it.


And the Band Played On by Randy Shilts

The book that framed how we talk about AIDS.


A Partner to the Poor: A Paul Farmer Reader by Paul Farmer

Three decades of writings by the patron saint of MPH students. A portion of the sales of the book go to Partners in Health, so don’t be cheap—buy from the publisher, okay?


Beautiful Unbroken: One Nurse’s Life by Mary Jane Nealon

The story of a nurse learning about life, death, and poetry.


Conquest: Sexual Violence and American Indian Genocide by Andrea Lee Smith

American Indian women have the highest rates of poverty-related illness, domestic abuse, and rape of all groups of women in the country—and there are solutions to these problems.


Crazy Like Us: The Globalization of the American Psyche by Ethan Watters

Great. Now America is exporting neuroses, too.


Heart of Power by David Blumenthal and James Morone

The history of how well (or poorly) presidents handled health reform efforts.


Poisoned: The True Story of a Deadly E. coli Outbreak that Changed the Way Americans Eat by Jeff Benedict

The legal history of the 1993 Jack-in-the-Box E. coli outbreak


Rabid: A Cultural History of the World’s Most Diabolical Virus by Bill Wasick and Monica Murphy

The terrifying history of rabies can teach us how to deal with emerging infectious diseases.


Smoke and Mirrors: The War on Drugs and the Politics of Failure by Dan Baum

The War on Drugs has disastrous consequences, and 175 interviews with the people intimately involved in it explain exactly what the problems are and what should be done next.


Superbug: The Fatal Menace of MRSA by Maryn McKenna

Get ready to be terrified by the strength and impact of MRSA (drug-resistant staph infections).


The Bernard Turnock Reading Room

Read the greatest hits from Bernard Turnock by downloading the (free!) PDFs he provides online.


The Checklist Manifesto by Atul Gawande

Follow the lead of pilots and simply make and follow a checklist to improve outcomes.


The Immortal Life of Henrietta Lacks by Rebecca Skloot

The story of the exploitation of Henrietta Lacks and its impact on modern medical research.


The Purity Myth: How America’s Obsession with Virginity is Hurting Young Women by Jessica Valenti

Linking virginity and purity with women’s value damages women’s self-worth as it permeates popular culture, abstinence-only education, and cultural stereotypes.


The Quest for Health Reform: A Satirical History by Georges C. Benjamin and Theodore M. Brown

The history of health reform as told by political cartoons. If you remember how to interpret political cartoons from your high school AP US History class, this is the book for you.


The Spirit Catches You and You Fall Down by Anne Fadiman

The ultimate story of cultural incompetence.


When Prayer Fails: Faith Healing, Children, and the Law by Shawn Francis Peters

Tackling the difficult issue of parents who refuse medical treatment for their children while respecting religious liberty and public health concerns has been an issue for more than 100 years.


While We Were Sleeping: Success Stories in Injury and Violence Prevention by David Hemenway

Public health often does its work behind the scenes, so this book illuminates 60+ successful initiatives in the field of injury and violence prevention.


Wiped: The Curious History of Toilet Paper by Ronald H. Blumer



Are there any must-reads I missed? Have you read any of these books?


Thank you to Leah, Alisen, Amanda, Genna, Emily, the APHA Pinterest account, and various Goodreads contributors for their help creating the intellectual part of my summer.