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In 1965, in an impoverished rural county in the Mississippi Delta, the pioneering physician Jack Geiger co-founded the nation’s first community health center. Many of the children Geiger treated were seriously malnourished, so he began writing “prescriptions” for food — stipulating quantities of milk, vegetables, meat, and fruit that could be “filled” at grocery stores, which were instructed to send the bills to the health center, where they were paid out of the pharmacy budget. When word of this reached the Office of Economic Opportunity in Washington, which financed the center, an official was dispatched to Mississippi to reprimand Geiger and make sure he understood that the center’s money could be used only for medical purposes. Geiger replied: “The last time I looked in my textbooks, the specific therapy for malnutrition was food.” The official had nothing to say and returned to Washington.

In some ways, the United States has come a long way since Lyndon Johnson declared the “war on poverty.” But in others, we’re still at square one. We now have a variety of federally-supported nutrition programs, but the health care system remains senselessly disconnected from the “social determinants of health.” In this regard, the United States has fallen behind the rest of the world. If a politician in India announced a public health plan that neglected malnutrition, he would be ridiculed. Here, leaders make this kind of omission all the time. Almost all of the debate about the 2010 Affordable Care Act was consumed with questions about health care access and quality. But if we really want to improve the health of millions of people, we have to address the conditions that make them sick.

One of the most impressive organizations in the country that is developing an approach to do this is Health Leads, which mobilizes and trains about 1000 volunteers each year who staff resource desks located in the waiting rooms of 23 hospital clinics or health centers in Baltimore, Boston, Chicago, New York, Providence, R.I., and Washington. At these sites, doctors now regularly “prescribe” a wide range of basic resources — like food assistance, housing improvements, or heating fuel subsidies — which Health Leads’ volunteers “fill” — applying their problem solving skills (and tenacity) to identify resources anywhere they may be available.

Health Leads was co-founded by Rebecca Onie in 1996, while she was an undergraduate student at Harvard University. Onie had first witnessed the intimate relationship between poverty and health while volunteering at Greater Boston Legal Services, where she assisted low-income clients who had housing problems. Many lived in dilapidated apartments with leaky pipes, broken windows, rooms full of mold, and walls infested with cockroaches and rats. Often families couldn’t afford to pay for heat. Towards the end of the month, some ran out of food. Onie found herself interviewing mothers whose children came to the office wheezing and coughing from asthma and lung infections — health problems caused or triggered by bad housing. Often, the children had been in and out of hospitals for years; many had fallen far behind in school.

One day, she read a magazine story about Barry Zuckerman, chairman of pediatrics at Boston Medical Center (B.M.C.), who had established the Medical-Legal Partnership for Children, a program that connected doctors with lawyers to assist patients (it has since spread to more than 235 health institutions nationally). Close to 70 percent of the patients at B.M.C. are poor and Zuckerman, like Geiger, had grown tired of treating children, only to see them readmitted to the hospital because nothing was done to address the causes of their illnesses. In some cases — as when a child has chronic asthma attacks because the landlord refuses to clean up mold — a lawyer could be more effective than a doctor.

“I thought bringing lawyers into the hospital was brilliant,” recalled Onie. She called Zuckerman to see how she could help and he invited her to spend six months talking to people in the unit. There Onie found doctors who were “smart, passionate and totally committed to their patients” and yet “stymied in terms of their ability to bring about the health outcomes they wanted.” Some physicians told her they knew they should be asking more about food, housing or social issues, but they were afraid of opening a “pandora’s box.” “I have no idea where to begin to address the problems,” one physician told Onie. “I have 13 minutes with each patient.” (Studies reveal that doctors are reluctant to inquire about issues — domestic violence, for example — when they feel powerless to intervene.)

Onie thought that students could help. With Zuckerman, she founded Health Leads (formerly Project Health) to recruit and train students to provide patients with connections to resources deemed necessary by doctors and other health care providers. “What are college students built to do?” asks Onie. “Track down information!” She adds: “Say your client is a Latina mother working two jobs. She needs food supplements. She has no transportation. Your job is to locate a food pantry within walking distance of her home that’s open after 8:00 p.m. and has a Spanish speaker on staff. That’s a perfect problem for a college student. It’s like a really fancy Google search.”

From the outset, Onie made the decision to work only with students who demonstrated high levels of motivation and commitment. In some of Health Lead’s sites today, as few as 10 percent of students who apply get selected. This has had the effect of attracting serious volunteers. In 2010, the organization reported that in 57 percent of cases its volunteers secured a needed resource within 90 days. This year, Health Leads will serve 9,300 patients and families — not a huge number given the scope of the problem it seeks to address — but the approach is gaining momentum.

One indication is that, where Health Leads works, doctors are changing their behavior. In the Children’s National Medical Center, in Washington, for example, over the past year, there has been a 300 percent increase in doctors “prescribing” Health Leads through the hospital’s Electronic Medical Record. The resources they request for patients include things like exercise or summer meal programs for children or subsidized child care for mothers, so they can find work and afford better food and housing.

Health Leads is also demonstrating that it can improve the efficiency of social workers. In some of the large urban hospitals where the program operates, the ratio of patient visits to social workers is close to 25,000 to 1. Because students can handle basic — but time consuming — cases, social workers can concentrate on what they’re trained for. At The Dimock Center, in Roxbury, Mass., initial data suggests that the program has doubled the time social workers can devote to therapeutic work.

Health Leads is also preparing a pipeline of new health care leaders. Two thirds of its students are either in pre-med tracks or pursuing careers in health, and the exposures they are getting are likely to shape the way they think about health care. As one volunteer said: “When I’m a doctor, I will never prescribe antibiotics that say ‘take with food’ without making sure that the family actually has food in the house.”

Many health care professionals know that social conditions impact health more than medical care. In a survey conducted by Health Leads at Bellevue Hospital in New York, almost every pediatric primary care provider said the failure to address social and psychological needs “impairs” their ability to treat patients effectively. The vast majority said that the hospital needed a standardized system to screen for these needs on routine well-child visits. But 80 percent said it lacked the capacity to do it.

There is very little money available for this work. Medicaid doesn’t generally reimburse social workers for non-therapeutic tasks. Most of the time, this kind of assistance falls through the cracks. Society then spends oodles of money treating the crises that follow. “There is a tension between what we all know, and agree, needs to be done, and what we are doing,” says Onie. “As a society, we haven’t yet decided that we actually want less emergency room visits.”

Just a year ago, Onie thought that Health Leads’ biggest obstacle would be getting doctors to pay attention to patients’ social needs — given all the demands on their time. Today, the organization is getting so many referrals from doctors, for the first time in its history it has long waiting lists. Five decades after the war on poverty, a work force that can systematically address the social causes of illness is still to be built. Health Leads offers a model of how it might work. A broader system could incorporate students, community health workers, and lay workers. It need not be a perfect solution, nor an expensive one. But something has to be done. And the big challenge is getting health care decision makers to prioritize and pay for it. As Onie says: “How would we ever think that we’re going to secure a return on our health care dollar until we start dealing with these social factors?”

Source: http://opinionator.blogs.nytimes.com/2011/07/28/treating-the-cause-not-the-illness/?hp

Canada is cracking down on the amount of cadmium that can be found in children’s jewelry.

A proposed guideline setting a limit for the first time was announced Monday by Health Minister Leona Aglukkaq, and it comes less than a year after her department asked manufacturers to voluntarily stop producing, importing and selling children’s jewelry made with the metal.

Cadmium is often used as a substitute for lead in cheap children’s jewelry. Health Canada says there is no known risk to wearing the products, but they can be dangerous if licked or sucked on repeatedly, or if swallowed.

The government has regulations on the amount of lead that can be used in products, but there were no limits, in the form of guidelines or regulations, on cadmium.

“Our goal is to reduce the level of cadmium in children’s jewelry to a level that is protective of health, so that parents and child care providers can feel confident about the jewelry products that their children wear,” Aglukkaq said when she made the announcement at a daycare in Ottawa.

When Aglukkaq made her appeal to industry last October, she said the government might introduce mandatory limits if companies did not comply with the request.

Health Canada isn’t moving yet to bring in regulations, but the guideline it is proposing suggests a total cadmium concentration in children’s jewelry of 130 parts per million, or 0.013 per cent of its weight.

Regulation still an option

Aglukkaq said regulations take a long time to develop and that Monday’s announcement is part of laying the groundwork for them.

“Everything that we are doing right now is work that is required for regulations and can be used to develop regulations,” she said. “Going through the regulatory process is a much slower process than establishing the guidelines, so we’re moving as quickly as we can and regulation is always an option,” she said.

Aglukkaq said the proposed guideline makes the government’s expectations of industry clear and that Health Canada will monitor the marketplace and “take appropriate action” when levels of cadmium in excess of the guideline are found in children’s jewelry.

The federal government now has more power to ensure manufacturers follow regulations and guidelines since passing the Consumer Product Safety Act. If a product is found to exceed the cadmium guideline, Health Canada may order a risk assessment of the specific item. If it’s deemed to pose an “unreasonable hazard” it could order a recall or take other actions.

Industry stakeholders have until Oct. 10 to provide comments on the proposal and then Health Canada will confirm the guideline.

Aglukkaq said the federal government will be doing another round of product testing this fall to see whether industry has complied with the government’s advisory that it should stop selling products with cadmium.

She said Health Canada believes manufacturers are in compliance, but if they aren’t, the powers afforded to the government through the Consumer Product Safety Act will be used.

Source: http://www.cbc.ca/news/health/story/2011/07/25/pol-health-cadmium.html

By Deepak Chopra

Between work, raising a family and coping with an uncertain economy, stress has become a “normal” part of daily life for most people. That could explain why so many Americans — about 16 million at latest count — have started taking yoga classes or doing yoga at home. This ancient practice, which started in India more than 4,000 years ago, connects mind and body through a series of postures, breathing exercises and meditation. By stretching and toning the muscles, flexing the spine and focusing the mind inward, yoga helps reduce stress. That can impact your overall health since stress plays at least some role in many illnesses. Studies show that chronic stress doubles the risk of heart attack, for instance.

How yoga may promote health Research into the health benefits of yoga is still in its infancy. But recent pilot studies point in promising directions. Yoga has been shown to lower blood pressure and heart rate, which can help reduce a person’s risk of heart disease. There may be other heart benefits, too: A 2006 study found that yoga helped lower cholesterol levels and improve circulation in people who have cardiovascular disease. Some hospitals have incorporated yoga into their post-cardiac rehabilitation programs.

While the evidence of yoga’s success in reducing a person’s body mass is mixed, one study did find that yoga can help people lose weight by leading them to a healthier lifestyle. The study reported that people who regularly practiced yoga started eating less, eating more slowly, and choosing healthier foods. They also showed fewer symptoms of eating disorders.

Many people report that yoga gives them an overall feeling of wellbeing. But research shows that it may also help alleviate specific kinds of pain, including migraine headaches, lower back problems, arthritis and pain during childbirth. Researchers are not sure what mechanism is at work, but one theory is that the yoga postures work like the way massage works. When a yoga posture places pressure on a nerve fiber, the signal for “pressure” is sent quickly to the brain via myelinated (insulated) nerve fibers, while the signal for “pain” reaches the brain more slowly via less myelinated nerve fibers. The signal for “pressure” closes the receptor gate and shuts out the “pain” stimulus. Another theory is that yoga causes an increase in serotonin, the body’s natural anti-pain chemical.

While more research is needed into these areas, people who practice yoga have also reported that they experience less insomnia and better digestive health. Pregnant women in particular seem to have an easier time sleeping when they do yoga. They are also less likely to develop high blood pressure or deliver prematurely.

Calming the mind Since yoga involves the mind as well as the body, it’s not surprising that it may help reduce anxiety and depression, especially in people whose anxiety is related to an illness like cancer. More research is needed to learn exactly how yoga affects mood, but a 2007 study may provide a clue: It found that in experienced yoga practitioners, a 60-minute yoga session increased levels of a neurotransmitter called GABA. Low levels of GABA have been linked to depression and anxiety disorders. Another pilot study suggests that yoga may influence depression by increasing the alpha waves in the brain. Alpha waves are associated with relaxation. Yet another possibility is that yoga reduces the amount of cortisol, a hormone that the body releases in response to stress. Some scientists think chronic high levels of cortisol may be tied to depression, as well as impaired immune function.

If the potential health benefits of yoga aren’t enough to make you want to try it, consider this: Yoga can also make you look more toned and fit and help you move with greater ease, especially as you grow older. A 2007 study of the Hatha yoga style showed that it increased muscular strength, flexibility and endurance. It’s no wonder that many athletes use yoga to cross-train.

Getting started You don’t need a lot of expensive equipment or to be in tiptop shape to start practicing yoga. All it takes is loose clothing, a mat (some classes will provide mats) and the desire to learn.

There are several different styles of yoga. Most use a series of postures designed to stretch and strengthen muscles and also use controlled breathing to quiet your mind. The most popular style in the U.S. is Hatha yoga, a relatively slow-moving, gentle style. Other styles such as Ashtanga (also known as power yoga) are more vigorous. Find out about the different kinds of yoga that are offered at classes in your area. Choose the style that fits your goals and level of fitness. You can also get started by using a good instructional book or DVD at home, although it’s useful for beginners to start with a class. If you are pregnant or have any serious health conditions, talk to your doctor before you begin. Once you start a class, let your teacher know about any injuries or health issues.

Whichever style of yoga you choose, take it slowly at first. Don’t try to force yourself into difficult poses at the beginning. After a while, you will develop more flexibility, strength and stamina. Your teacher shouldn’t push you to do poses that aren’t comfortable. If your teacher is going too fast, talk to him or her, or look for a class that is a better fit.

While yoga won’t cure everything that ails you — or make your boss nicer — it will help you deal with stress better. And that could make a big difference in your overall health.

Learn more about the benefits of exercise