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.

Action Phase Podcast Episode 2

This week, it's all about drugs, violence, and psychology as I talk with Kate Schaeffer. She's the Alcohol and Other Drug, Interpersonal Violence, and Mental Health Coordinator at the Wellness Resource Center at Temple University. You can download the episode by going here and saving the page as an mp3.

Or you can listen to it right here!

https://ia601904.us.archive.org/21/items/KateSchaeffer-ActionPhasePodcastEpisode2/Ep2_KateSchaeffer_Final.mp3

Friday Five: 9/11, tobacco in India, painkiller labels, Chobani recall, child abuse & neglect

Each Friday, I use five sentences to summarize and comment on five important, interesting, or just plain amusing health stories from the week.  

9/11 responders are suffering from cancer

While we remember the 12th anniversary of the attacks on the World Trade Center, another attack is being waged upon the responders: cancer. So far, 1,140 people have been certified by NIOSH to have 9/11-related cancer. The types of cancer are varied—from non-melanoma skin cancer to non-Hodgkins lymphoma to colon cancer—and thankfully, the September 11th Victim Compensation Fund will cover all related medical and mental health expenses. However, an important deadline approaches: if a person knew of their related medical condition before October 2011, he or she must sign up with the Fund before October 3, 2013 in order to have their treatment covered. If you know anyone who may be eligible for this benefit, please (1) thank them for their selflessness and (2) tell them to sign up ASAP.

 

Tobacco + India = Bad News

Approximately 275 million people out of India’s 1.2 billion population use smokeless tobacco or cigarettes. According to a report from the International Tobacco Control Project, the country could see 1.5 million deaths annually if the number of tobacco users is not reduced by 2020. What’s even more alarming is that 94% of tobacco users surveyed said they had no plans to quit, despite government efforts to curb consumption and self-reported regret for beginning the habit. Citizens groups also advocate for tobacco-free living. This ad from Cancer Patients Aid Association is an example of the kinds of messaging Indians receive.

 

Source

 

New labels for some, but not all, narcotic painkillers

The FDA has announced updates to the labels for extended release narcotic painkillers to remove the idea that the painkillers should be prescribed for “moderate-to-severe pain.” Instead, opiates like OxyContin (oxycodone) and MS Contin (morphine sulfate) should be prescribed only when a patient’s pain cannot be controlled by other methods. These changes do not apply to fast-acting painkillers like Percocet (acetaminophen and oxycodone) or Vicodin (acetaminophen and hydrocodone) because the FDA sees that class of opioids to be less susceptible to abuse and overdose. Hopefully the new label will encourage doctors to think carefully about which painkillers they prescribe. The misuse of these drugs is out of control, and as doctors are the gatekeepers of prescriptions, their cooperation is essential to reducing addiction and unintentional deaths.

 

Chobani yogurt is moldy

Beloved and wildly popular Chobani brand Greek yogurt has been recalled. The problem of bloated, exploding containers is said to be due to contamination by the mold Mucor circinelloides. Although this kind of mold is not known to cause gastrointestinal problems, 89 people have reported nausea and vomiting after eating the recalled yogurt. That said, if your breakfast is fizzing through the lid, please don’t eat it. Let’s have some common sense, okay?

 

New child abuse and neglect report demands changes to the system

A report released this week from the Institute of Medicine described the fractured, underfunded, and unevaluated way the US researches and addresses child abuse and neglect. There are more than three million reports of abuse each year, involving at least six million children. The most common form of mistreatment is neglect, or when a caregiver fails to provide food, supervision, protection, medical care, education, or nurturing and affection. The full report gives a sense of how poorly the US manages child abuse and neglect, and this infographic also gives the basics. Children who are victims of abuse or neglect are far more likely to have serious health problems, including mental health issues, so eliminating violence against children should be at the forefront of public health efforts.

 

This week’s Friday Five is extra-depressing, so I’m going to leave you with a bonus uplifting story:

Wearing a sandwich board may help you find a kidney donor

Larry Swilling of South Carolina has been walking around wearing a sandwich board asking for a kidney donor for his wife Jimmie Sue. A complete stranger, a woman named Kelly Weaverling from Virginia Beach, decided to get tested and was found to be a match. The transplant happened on Wednesday and both Jimmie Sue and Kelly are doing well. Bonus: Larry’s efforts have led to 125 new registered kidney donors in South Carolina.

Friday Five: Chicago, ACA, firefighters, prescription drugs, vaccine recall

Each Friday, I use five sentences to summarize and comment on five important, interesting, or just plain amusing health stories from the week.  

Fourth of July shootings in Chicago

This Fourth of July weekend is proving to be deadly for Chicago. Yesterday, eight people were killed and more than 30 were hurt in shootings across the city. The youngest victim is just five years old, and was shot while attending a party in a park with his family. These shootings are a disgrace, as is the lack of national coverage of the violence permeating Chicago. Victims’ stories should be plastered across every news station and website, and the nation should be reviving the post-Sandy Hook gun conversation in light of this inexcusable violence.

 

Another ACA delay

The Obama administration added to the confusion surrounding the Affordable Care Act by pushing the employer mandate deadline back one year to January 1, 2015. Another instance of caving to private sector demands means increased misunderstanding for the public. The law was incredibly complicated as written, and the administrative tweaks, House repeals, and flat-out lies disseminated by the media ensure that nobody has any idea what’s going on. The ACA is the single most important change to health care the US has seen since 1965, and its frustrating to watch it falter. Hopefully, the exchanges will still open as scheduled on October 1.

 

Firefighters killed in Arizona fires

Nineteen elite firefighters were killed on Sunday battling a blaze that is still only 45% contained. Their deaths have reminded us that the people suffering from these fires are not only those who lose their homes, but the people who are willing run into the flames to try to protect those homes. We’re learning about the hotshot teams specially trained to fight wildfires, an aspect of firefighting that was unknown to many people. I’ve been trying to imagine what it’s like to do what these teams do: go out to the fire, live near it for days, battling it while awake and smelling it while you sleep. I am in awe and very grateful.

 

More ‘scripts, more problems

This was a big week for news about prescription drugs. A brief rundown:

  • 70% of Americans take at least one prescription a day, mostly antibiotics, antidepressants, or painkillers
  • The number of fatal overdoses in women quadrupled between 1999 and 2010, and approximately 42 women die daily from overdoses
  • The FDA busted 1600 illegal online pharmacies

 

Hepatitis B Vaccine recall

Merck issued a recall this week for one lot of the Hepatitis B vaccine Recombivax. The issue is not with the vaccine itself, but with the glass vials that may easily crack. Merck is concerned about the sterility of the vaccine, and the FDA assures consumers there’s no need to be revaccinated if a doctor administered one of the recalled lot. The anti-vaccine websites I visited seem to have not picked this up yet, so maybe this vaccine news won’t be misconstrued. We can only hope.

In honor of yesterday's Fourth of July holiday, here's a little Katy Perry to get you dancing:

http://www.youtube.com/watch?v=QGJuMBdaqIw

Friday Five: violence, HPV, obesity, smog, Obamacare

Each Friday, I use five sentences to summarize and comment on five important, interesting, or just plain amusing health stories from the week. Global rates of violence against women are alarmingly high

This week, the WHO released a study showing that more than 30% of women around the world have been victims of physical or sexual violence, particularly from their spouse or partner. The report also outlines the health issues associated with violence against women: death, depression, alcohol use, STIs, unwanted pregnancies and abortions, low birth weight babies. The WHO recommends that health care providers take violence more seriously. These findings remind us that violence is not a far away issue that impacts other people—all of the WHO regions have violence rates hovering between 23-38% (map). Whether we realize it or not, we all know women who have experienced violence against them, and we are all responsible for ensuring women have the education and mobility they need to keep themselves safe.

 

HPV rates are lower in teen girls thanks to vaccine

And now for some good news: the prevalence (number of cases currently in the population) of vaccine preventable HPV in teen girls has dropped 56% since the introduction of the vaccine. The ultimate goal is to have 80% of American children vaccinated in order to create herd immunity, meaning that enough people are vaccinated so the virus has nowhere to go. However, only about half of teen girls have gotten the necessary three doses of Gardasil or Cervarix. It’s time to stop stalling. Vaccinate kids and help prevent them from developing cervical, anal, or—as Michael Douglas reminded us—throat cancer.

 

AMA declares obesity a disease

The American Medical Association (AMA) voted this week to define obesity as a disease, identifying it as a complex issue that requires therapeutic medical treatment. They hope to reduce stigma and understand obesity to be a disease because it impairs some body functions. Critics denounced the decision, saying that because obesity is defined using BMI, it is not a precise diagnosis and that obesity has no specific symptoms of its own, only that it a contributing factor to other diseases. Although obesity is often characterized as a willpower and laziness issue, the resolution, as quoted in the New York Times, says:

The suggestion that obesity is not a disease but rather a consequence of a chosen lifestyle exemplified by overeating and/or inactivity is equivalent to suggesting that lung cancer is not a disease because it was brought about by individual choice to smoke cigarettes.

Hopefully, the AMA’s decision will lead to increased insurance reimbursement for obesity treatments, including nutritionists and gym memberships, as well as medical interventions and therapy.

 

Singapore is covered with smog

Fires in Indonesia are causing dangerous smog in the country and Singapore. Though no one has fessed up to starting the fires, they are likely due to illegal land clearing practices in Sumatra, which is west of Singapore. Today, Singapore’s Pollution Standards Index (PSI) hit 401, far higher than the “dangerous” level defined by a PSI of 300, and is considered “life-threatening” to the ill and elderly. Smog is a mixture of accumulated greenhouse gases and smoke, and is made worse by the combination of pollutants, sunlight, and heat that creates ozone. Smog causes serious respiratory, eye, and skin problems, and this smog is so thick visibility is seriously impaired.

 

Dems love the term “Obamacare,” Republicans don’t

The Kaiser Family Foundation June tracking poll shows that when referred to as “Obamacare,” 73% of Democrats responded favorably to the Affordable Care Act (ACA), as compared to 58% when the ACA was called “health reform law.” Republicans, however, saw an increase in unfavorable responses when the ACA was called “Obamacare,” from 76% to 86%. Apparently, the pejorative likely coined by none other than Mitt Romney has been successfully appropriated and turned into a rallying point for Democrats in support of the ACA. Obama is a linguistic master, and this shows he can turn even the most negative epithet into a compliment. Take that, Sarah Palin!

It's the first day of summer! This lion knows how to celebrate:

http://www.youtube.com/watch?v=mV1CVTPVAJg