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Gambling and Smoking and Drinking! Oh My!

Posted By Jonathan Noel, Monday, April 13, 2015

Under the guise of fixing the budget and economic growth, Gov. Dannel P. Malloy is systematically removing some of the last controls Connecticut has at limiting the social and economic impacts of legal addictions.  The health consequences of these decisions are rarely part of the decision making process, and if effect, the state is creating a future public health problem by pushing for these policies.  Let’s run down the list.

Gambling

A bill is currently making its way through the legislature that would allow the Mashantucket and Mohegan tribes to jointly open up to 3 new casinos in Connecticut.  Connecticut is highly reliant casino revenue to plug budget deficits.  As early as 2008, Foxwoods and Mohegan Sun contributed nearly $5 billion dollars to the general fund since their inception. This has not come without consequences.  Here are the results of a 2009 study prepared for then Governor Jodi Rell.

  • The city of Norwich experienced a 27% increase in the number of motor vehicle accidents between when the Foxwoods casino opened to 2008 and was required to spend over $280,000 in police overtime in 2008 due to a 76% increase in the number of service calls.

  • Connecticut’s casinos cost nearby towns $1-2.5 million a year, and the casinos have cost the state nearly $16 million from 2004 to 2008 in regulatory costs.

  • Since casino gambling was legalized in Connecticut, arrests for embezzlement have increased by nearly 500%.

  • The proliferation of sub-standard housing in surrounding communities have forced cities to hire “Blight Officers”.

  • The prevalence of pathological and problem gambling increased over the last decade.

These are the costs of expanding gambling in Connecticut. 

Smoking

Connecticut has one of the worst records in the country for spending on anti-smoking efforts.  Of the $2 billion dollars given to the state from the Master Settlement Agreement since 2000, just about 10% has gone to Connecticut’s Tobacco and Health Trust, created to support tobacco prevention, education and cessation efforts.  The majority of this money, $170 million, has been taken by the state to help balance the budget or for other programs.  To put that in perspective, we spend $430 million for Medicaid costs each year for diseases caused by smoking.   Funding that would be well spent on tobacco cessation efforts is again slated to be taken for close budget loopholes.  Legislation has already been passed to suspend the Trust’s activities for 2016.

Drinking

In 2012, Gov. Malloy succeeded in lifting Connecticut’s ban on Sunday alcohol sales.  In 2015, Malloy is pushing for even greater expansions of alcohol availability and lower prices.  To say these efforts are misguided in an understatement.  There are numerous, consistent results from around the world that increasing alcohol availability increases alcohol use and alcohol-related problems.  These problems include more DUI’s, more motor vehicle accidents, more violence, and more deaths.  Not surprisingly, if we strengthen alcohol control policies, we see less alcohol use and less alcohol-related problems.  Connecticut already has an alcohol problem.  Over 18% of adults are binge drinkers with over 6% being classified as heavy drinkers.  Over 1/3 of our middle and high schoolers are current drinkers and 20% are binge drinkers.  These numbers scream for greater control, not less.

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Experiencing an APHA Meeting

Posted By Jonathan Noel, Tuesday, June 17, 2014
Last week, I had the good fortune to represent CPHA at the APHA President-Elect meeting (I am not the president-elect though which put me in a distinct minority) in Washington, DC, and it was definitely an experience.  This was the first time I was able to talk to other state affiliates about affiliate related problems, ask how they might solve them and offer some of my own advice as well.  So here is what I learned.

1) Numbers Matter - This is straight from the APHA Executive Director Georges Benjamin.  When APHA or CPHA advocates on the behalf of its members, the number of members really matter.  The more members there are, the more weight our information has in the eyes of politicians.  In addition, the number of phone calls or emails that a politician receives for one side of an issue is also important.  In some cases, the opponents of bill that APHA supports send 100 messages for every 1 of ours.  Those numbers aren't conducive to legislative victories.

2) Each State Has Similar Problems - By that I mean we all struggle using what resources are available to us efficiently.  Everyone has these great ideas for what they want to do in their state or benefits they want to offer to their membership, but lack of resources is holding them back.  I heard some great ideas to solve some of these issues and hope to share them with the board at some point.

3) APHA Is There to Help - As we sat through a very long afternoon session on the structure and function of APHA, a common theme among all the speakers was the willingness to help the affiliates.  The communications team offered to review anything from messages sent out to members or press releases sent to reporters.  The Section team offered help to affiliates to bridge the gap between affiliate members and APHA Section members.  And I can't forget the Affiliate Affairs team who set this great meeting up.  They basically offered to help on whatever problem we could come up with, within reason of course.

As I said, I learned a lot in just 2 days.  I met the leaders of other affiliates and hopefully the lines of communication with remain open far past the end of this meeting.  For now, I have my notes, my recommendations, and my ideas for what to do over the coming year.

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Let the Great Minimum Wage Experiment Begin

Posted By Jonathan Noel, Friday, June 6, 2014
On June 2nd, or sometime thereabouts, the city council of Seattle, WA unanimously approved a $15 per hour minimum wage through the city, and the great debate about it's effects has been begun.

Some argue that it will kill small business, force layoffs, reduce the hours of employees who are retained and send retail prices sky high.  Others argue that by giving the lowliest workers a living wage, they will no longer be so reliant on entitlement or welfare programs and they won't need to consider going to the local food bank instead of the grocery store.  Up until now, this argument has been largely theoretical.  Sure, states have incrementally raised the minimum wage (Connecticut recently voted to increase the minimum wage to $10.10 by 2017), but honestly, those increases barely keep up with inflation.  This is different.  This is a real increase that may cause real change.

The problem is that we don't actually know whether that change will be positive or negative since all the analyses up to this point has, again, been largely theoretical.  But that is why it is so exciting.

There are an endless amount of public health studies that can be done, from the ecological to the individual, and if anyone is running a cohort study out of Seattle right now, they should be jumping for joy.  We can finally test whether a living wage really does lift people out of poverty or condemn them to more employment.  We can finally test whether a living wage will increase general health and better health care utilization.  We can finally test a whole host of other outcome measures.

Honestly, I can't say whether a $15 minimum wage will actually improve the lives of people working in Seattle or if it will fail catastrophically.  I hope that it works and I'd support pretty much any measure that lifts the floor to society.  All we can do now is wait and see.

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Can DIY Science Speed Innovation?

Posted By Jonathan Noel, Tuesday, May 13, 2014
I have a problem.  An addiction really.  There is a library bookstore that sells cheap used or donated books.  Most of the books are pretty new or maybe read only a couple of times.  In any case, it is the only place where I just buy as many books as possible (It usually averages $1 per book).  I bring this up because I picked up a book on do-it-yourself science, a movement that wants to bring bench-top science into the community and find ways around the big business approach to healthcare solutions.

Reading through it, I realized that I've actually witnessed the problem with big business science first hand.  I was part of a research collaboration that was developing a cancer vaccine.  Our group was tasked with finding vaccine targets while a second was supposed to supply the vector to deliver the vaccine. (There was a 3rd group too but I have no idea what they were doing.)  It turned out that they vector this other group developed was innovative enough for them to file a patent and receive a patent for their work.  But once they received their patent, big business came calling.

We learned about this group's business relationships when we realized they weren't providing any of the grant deliverables that had been promised.  It turns out they sold the rights to their vector patent to a pharmaceutical company for hundreds of millions of dollars, $300 million if I'm not mistaken.  While they are financially set for life, it set our research back by a year or more.

In the DIY science world, this wouldn't be an issue.  Information would be freely shared.  It would be an open-source science world in the exact same form as open-sourced software (that's how Linux and Firefox were developed).  This part of the movement is very intriguing to me.  If a discovery, a truly groundbreaking discovery, was available to anyone, not just those who can afford it or have really good insurance, it would change health, healthcare and public health as we know it.

But the part of DIY science that makes me hesitate is that it is happy to function outsite of regulatory control.  One chapter talks about a man who has created a personalized pharmaceutical company, whereby treatments are tailored to each individual, and it appears he is proud of the fact that no regulatory agency can shut him down.  In essence, he is running multiple, simultaneous clinical trials, all with n = 1 subjects.  There is no regulatory approvals for the treatments.  There is no informed consent and there certainly isn't approval from an institutional review board.

I would fully support science being more open, less hidden behind the walls created by patents or investors' bank accounts, but there needs to be some regulation.  There needs to be some system in place to protect the safety of people who are sick, want to be healthy, and may be desparate.  DIY science has the potential to push healthcare forward by leaps and bounds, just like open-source software did to the computer industry, but its results will have to be tempered. 

Still, I hope they find something big.  It could be the next transitional moment in health science.

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Filibustering the Surgeon General, Courtesy of the NRA

Posted By Jonathan Noel, Friday, May 9, 2014
Dr. Vivek Murphy's confirmation to be Surgeon General has stalled, languishing between the nomination and confirmation stages for very obvious, but completely ridiculous, reasons.

Guns and the NRA.

When Dr. Murphy was testifying at his confirmation hearing, he intimated that guns were a public health issue.  (I'm not sure how to argue against that.  Firearms killed nearly 32,000 people last year.)  But that was enough to get the NRA, Republicans, and some red-state Democrats up in arms (pretty good pun, right?).

He'll take away your guns! He use his power to attack the second amendment! He'll make you make sure you are a responsible gun owner!

There are a lot of things to take away from this ridiculous fight.  Another needless fight.  Republicans doing whatever they can to make sure nothing gets done.  A politicized argument for what amounts to a position with no actual power.

But the most concerning is the NRA.  The NRA is NOT a public health organization, and in my opinion, they do NOT look out for the safety and welfare of the country.  As so eloquently put by Paul Waldman, the NRA advocates for fear (seriously, go read his blog post. I think his description of the NRA is spot on), and represents the interests of the gun industry.  

Yet, here we are.  A public health appointee is held up by a non-public health organization.

Something isn't quite right about this.  The New England Journal of Medicine called it "policital blackmail."  The ironic part is that support from the NRA has no bearing on whether or not a politician wins an election.

In the short term, the Senate just needs to vote on Dr. Murphy's nomination.  The Surgeon General has done a lot of good, but it is still largely ceremonial, with no real power outside the issuing of reports.

In the long term, we need to find a way to change the way Congress functions so that they are less afraid of the next election, less influenced by organizations who don't belong in a debate, and more inclined to actually do something because doing nothing isn't working. 

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Rule #1: Know the Opposition

Posted By Jonathan Noel, Tuesday, April 29, 2014
CPHA advocates for many different bills, on many different causes.  Sometimes, if we are really lucky, all parties involved agree that the bill is good for everyone and there is no opposition.  Most of the time though, there is some opposition.  And some of the time, there is a lot of opposition, particularly when the subject is controversial.

Among the most controversial topics is the use of e-cigarettes.  Some people like them, some people hate them, and other just pretend they don't exist.  But there is general agreement that they need to be regulated, and CPHA was fortunate enough to be there when Rep. Esty and Sen. Blumnethal unveiled legislation restricting e-cigarette marketing.  Recently, the FDA has released a proposal to regulated e-cigarettes under the Family Smoking Prevention and Tobacco Control Act, of which I personally support.

But remember, I said e-cigarettes are controversial, and with controversy comes opponents.  In addition to the standard corporate interests who will oppose nearly all regulations, there is also a "grassroots" organization called the Consumer Advocates for Smoke-free Alternatives Association.  CASAA, as they call themselves, really did start out as a grassroots organization with little money and maybe too much time on their hands, and they genuinely believed that e-cigarettes were the greatest invention since they started smoking.  

That has sinced changed.  Not their belief that e-cigarettes are great, but that they are a grassroots organization, hence the quotation marks.

How do I know this? Carl V. Phillips, PhD.

Carl Phillips was once an associate professor at the University of Alberta, although never in public health, and has consistently taken tobacco industry money over the years.  He has been a paid consultant and testified in court in favor of tobacco industry interests.  He has received unrestricted grant money from U.S. Smokeless Tobacco, which has since be bought out by Marlboro maker Altria (formerly Philip Morris), and was forced to leave the University of Alberta due to his tobacco industry ties.

He is now the scientific director of CASAA.

CASAA is not a grassroots organization anymore.  They have ties to the tobacco industry, the smokeless tobacco industry, and the e-cigarette industry. 

So please, if you have an interest in tobacco control, public health, local health, national health, or anything to do with health, look over the FDA proposal, and submit your comments.  I know CASAA and the other tobacco industry lobbyists will be submitting theirs.

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We Were at a Press Conference!

Posted By Jonathan Noel, Friday, April 11, 2014
To kick off National Public Health Week, we were able to attend the press conference where Sen. Blumenthal and Rep. Esty unveiled their proposed e-cigarette legislation, and it was a very interesting environment to be in.

I've never been to a press conference, never seen the lights, the cameras, or the microphones.  The prepared remarks were pretty boilerplate.  We want to protect kids.  Kids are using e-cigarettes.  We need to stop kids from using e-cigarettes.  But the entertaining part had to have been the question and answer session.

Some of the reporters had very good, legitimate questions.  The 2 e-cigarette people who tried to make a scene?  Not so much.   One was from the Hartland Institute, a thinktank funded by the tobacco companies.  his argument was that since he quit smoking (still addicted to nicotine mind you) using watermelon flavored e-cigarettes, everyone should be allowed to have watermelon flavor.  He couldn't see, and probably will never see, that fruit and candy flavors make it easier for ANYONE to use e-cigarettes, not just former smokers.  He couldn't see that the baseline level for use among adolescents in nothing, and based on his comments, he made it seem like everyone is or is going to be a tobacco smoker.

Now, the other guy...he actually made a valid point.  He just didn't do his homework.  He asked why Congress wasn't going after alcohol companies for putting flavors in their products that could be attractive to kids.  I have to say, I agree with him.  We probably should talk about instituting a ban on flavors in alcohol products, but what he didn't realize is that alcohol marketing is already regulated, even if it is only marginal regulation.  It didn't help that he came wearing jeans and a wringled, unbuttoned shirt.  I know, I know.  He's just expressing who he is.  But if he wanted to be taken seriously, he probably should have dressed the part.

If you're interested in the legislation or want to see how the press conference went, follow the links below to articles and videos about the event.

http://courantblogs.com/capitol-watch/blumenthal-esty-push-for-new-e-cigarette-regulations/

http://ctmirror.org/esty-introduces-e-cigarette-bill/

http://www.ctnewsjunkie.com/archives/entry/blumenthal_esty_tackle_bubblegum_flavored_e-cigarettes/

http://www.wfsb.com/story/25093297/18-million-students-have-tried-e-cigarettes

http://mms.tveyes.com/Transcript.asp?StationID=1260&DateTime=4%2F7%2F2014+5%3A58%3A01+PM&LineNumber=&MediaStationID=1260&playclip=True&RefPage=

http://mms.tveyes.com/Transcript.asp?StationID=1260&DateTime=4%2F7%2F2014+12%3A02%3A04+PM&LineNumber=&MediaStationID=1260&playclip=True&RefPage=

http://mms.tveyes.com/Transcript.asp?StationID=1270&DateTime=4%2F7%2F2014+11%3A03%3A52+AM&LineNumber=&MediaStationID=1270&playclip=True&RefPage=

http://mms.tveyes.com/Transcript.asp?StationID=2780&DateTime=4%2F7%2F2014+5%3A53%3A11+PM&LineNumber=&MediaStationID=2780&playclip=True&RefPage=

http://mms.tveyes.com/Transcript.asp?StationID=1275&DateTime=4%2F7%2F2014+9%3A11%3A51+AM&LineNumber=&MediaStationID=1275&playclip=True&RefPage=

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Public Health and the Press

Posted By Jonathan Noel, Monday, March 10, 2014
Sometimes, I wonder how effective public health issues are at reaching the general population.  Don't get me wrong, our advocacy efforts are amazing and we have had a string of victories over the past few years, from Bisphenol-A in plastics to gun control to bans on the use of tanning salons for minors.  But just because we know an issue is important doesn't mean that the issue will resonate outside the confines of public health.

Well, my faith is restored just a bit.

As part of the Coalition for a Safe & Health Connecticut, CPHA is advocating for HB 5354 – AAC CHEMICALS OF HIGH CONCERN TO CHILDREN and HB 5035 – AAC TOXIC FIRE RETARDANTS IN CHILDREN’S PRODUCTS.  And the press coverage has been...well...a lot.  Surprising even.  I'm far too used to not seeing issues being reported on, gun control notwithstanding.

So here they are.  There may be more.  Hopefully there are more.  And hopefully, this won't be the last time a post like this comes around.

Bill would create list of chemicals harmful to children

New Study On PCBs In Paper, Clothing Raising Legislative Concerns

Connecticut Lawmakers Looking To Protect Children From Toxic Ingredients

New bill could find toxic chemicals in children’s products

Legislature Considering Hazards Of Chemical Exposure Unsafe For Children

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Maybe It's All In The Stars

Posted By Jonathan Noel, Thursday, March 6, 2014
Now, you are going to have bear with me on this one because it might take a little while to get to the end and it's not exactly public health, although almost everything can be made to involve public health. Ok, ok, ok, it involves public health too.

Now, part of UConn's plan for the future is to hire 200 science, technology, engineering, and math (STEM) faculty.  This, quite simply, is a good thing.  The STEM disciplines are the future and public health will need to find a way to be a part of that, but that's not the point of this post.  With the high attention levels the STEM disciplines are receiving from UConn, other universities, and the President, there is a particularly great need for everyone to have equal access to a STEM education.

Unfortunately, this is not the case.  There are huge disparities in the STEM workforce with Asians, mixed race, and non-Hispanic whites comprising nearly the entire working population.  What about women you ask?  Well, here's a little anecdote.  I roomed with an engineer in college and we were joking with him about how there aren't any girls in his classes.  One of us guessed that there must be 2 girls that he sees on a somewhat regular basis.  He looked at us for a moment, counted in his head twice, and said something to they effect of "Yeah, there are 2 of them."  Woman participation in the STEM fields is better than in the past but there is still at least a 2:1 men:women ration, which brings me to the point of this whole thing.

I wonder if it comes down to inspiration.  I've been reading a lot about scientific history lately.  How the greatest minds came up with the great theories and the great laws that govern the world around us, and they all have one thing in common...the stars.  Not that they all involve the stars, although many do, but that they could see them.  Clear as day.  Thousands of them each night with nothing but the moon in the way.  (When was the last time you looked at the southern horizon at night and could see the Milky Way?)

Now, here's another anecdote.  I walked out of work the other day and could barely see the stars in Orion's belt.  Needless to say, staring into an essentially black, blank canvas on another cold winter's night wasn't exactly the most uplifting experience.  But if I could look up and see even half the stars that are possible to see, perhaps that experience would be different.  Perhaps they could provide perspective, inspiration, or a number of other words I can't quite get think of at the moment.

Minority populations have tended to concentrate in urban environments with even greater light pollution than where I am and even less stars. 

I'm not arguing that light at night or the lack of stars in the sky at night is the sole reason for STEM disparities.  I'm just saying that maybe it is a part, and maybe it is a part that we too often overlook.

We all need inspiration once in awhile, right?  Something to restart the fire.  What better place to start than the stars? 

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Re-Defining "Clean Burning"

Posted By Jonathan Noel, Thursday, February 27, 2014
The other day, I was watching TV sometime between 9-10pm.  (I don't know the exact time.  Time blends together after a 14 hour day.) Anyway, one of the commercials was for "Clean Burning" natural gas that was mined, pumped, or otherwise obtained through fracking.  My issues with fracking will have to wait for another day, although I will say that the idea of breaking the rock underneath your feet is a little disconcerting.  No, this time is reserved for the concept of "clean burning."

The idea that something is "Clean Burning" made a lot of sense in, well, pretty much anytime before now.  The diesel in trucks contained excessive levels of sulfur, our gas engines pumped out lead, and power plants spewed particulate matter high into the air, allowing it to fall is areas that aren't even served by the power plant.  Connecticut is both a contributor and a victim of this effect. Even the Obama Administration has signed off on this clean burning idea through their Clean Coal research grants.

But can we really define anything as truly "clean burning?" 

What I'm getting at is that particulate matter isn't our only concern anymore.  The reduction in greenhouse gases are the primarily target for more clean air advocates at the moment, including the EPA. And if climate change is to ever be slowed (the cynic in me says it is already too late to stop it), aren't we going to have to change out minds about the dirtiness of carbon dioxide, CO2?  CO2 may be clear.  CO2 may not smell.  But it certainly isn't clean, right?

So if CO2 isn't clean, can any fossil fuel be "clean burning?" 

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