Air Pollution - Place Matters

Taken outside of McGlynn Middle School in Medford, MA

Earlier this month, the Chinese cities of Shanghai and Nanjing had such high levels of air pollution that schools cancelled classes and people were warned to stay inside.  The reason this made the US news was not because the levels of pollution were higher than China has seen before, but, in my opinion, because unlike the other cities that have experienced even higher pollution levels, most of us have heard of Shanghai.  Multiple cities in China have experienced pollution levels so high, they were off the 0 to 500 scale that China uses to measure them.  

The Health Effects of Air Pollution

The United States does not have the level of pollution that China has anymore (our pollution levels have improved as we have lessened our reliance on coal for energy and instituted environmental protection policies among other things).  However, 42% of Americans still live in areas with pollution levels are high enough to cause health issues. Some of the health risks from ozone and particulate matter pollution (the two most common) are:

1.) Premature Death: Research has shown that breathing even small amounts of ozone can shorten life.  Spikes in particle pollution can sometimes kill on the day they happen.

2.) Short Term/Immediate Breathing Problems: As the people of Shanghai learned this month, large amounts of pollution can make breathing noticeably more difficult.

3.) Cardiovascular Issues: These include arrhythmia and heart attack

4.) Asthma: Not only can pollution exacerbate asthma that is already present, but it also can cause asthma.

5.) Low Birth Weight: Children born in communities with higher pollution levels are more likely to have low birth weight as well as decreased lung function.

6.) Cancer: People who are exposed to high levels of particle pollution have a higher risk of developing lung cancer.

Place Matters: Who Is Affected?

It is not surprising that where we live dictates how much air pollution we are exposed to.  There are two types of areas where air pollution is higher than others.  The first is pretty obvious - industrial areas.  Industry requires energy often from coal or petroleum products which produce various pollutants.  In developed countries, we have decreased this type of pollution as technology has improved and environmental regulations have been set; however, in developing countries like China, the environment often loses out to economic concerns (just like it did in the US during the industrial revolution).  Because developing countries are by definition less wealthy than developed countries, poorer people around the world are exposed to greater pollution.  The second type of area that has higher pollution, especially in the US, is agricultural.  This may seem strange but the use of high powered machinery to farm often kicks up particulate matter and uses combustion engines that produce pollution.  Spraying pesticides and fertilizers on farmland also harm air quality.

If where we live affects our exposure to air pollution, we have to ask ourselves who lives in the worst places for air quality?  The answer is not surprising - the cities with the worst air pollution in the US also tend to have more people of color than the national average.  Below are two tables that compare the demographics of the US with the 11 cities with the worst air pollution - the first table has the 6 cities in California that made the list, the second contains the rest. (2010 Census Quick Facts)

Race / Ethnicity	US	Bakersfield, CA	Visalia, CA	Los Angeles, CA	Hanford, CA	Fresno, CA	Modesto, CA
White	72.4 %	56.8%	64.5%	49.8%	62.5%	49.6%	65%
African American	12.6 %	8.2%	2.1%	9.6%	4.9%	8.3%	4.2%
American Indian or Alaska Native	0.9 %	1.5%	1.4%	0.7%	1.3%	1.7%	1.2%
Asian American	4.8 %	6.2%	5.4%	11.3%	4.3%	12.6%	6.7%
Native Hawaiian or Pacific Islander	0.2 %	0.1%	0.1%	0.1%	0.1%	0.2%	1%
Two or more races	2.9 %	4.9%	4.6%	4.6%	5.4%	5%	6.3%
Hispanic or Latino	16.4 %	45.5%	46%	48.5%	47.1%	46.9%	35.5%

Race / Ethnicity	US	Phoenix, AZ	Pittsburgh, PA	Birmingham, AL	Cincinnati, OH	Louisville, KY
White	72.4 %	65.9%	66%	22.3%	49.3%	70.6%
African American	12.6 %	6.5%	26.1%	73.4%	44.8%	22.9%
American Indian or Alaska Native	0.9 %	2.2%	0.2%	0.2%	0.3%	0.3%
Asian American	4.8 %	3.2%	4.4%	1%	1.8%	2.2%
Native Hawaiian or Pacific Islander	0.2 %	0.2%	0%	0%	0.1%	0.1%
Two or more races	2.9 %	3.6%	2.5%	1%	2.5%	2.3%
Hispanic or Latino	16.4 %	40.8%	2.3%	3.6%	2.8%	4.5%

Conclusion

The highlighted cells are showing when a city has a higher percentage of people in a certain race or ethnicity.  As you can see, in many of these cities, the difference in population is dramatic.  This data shows that at the city level, there are disparities in air pollution exposure, but there is also some evidence that within cities there are disparities that even further target communities of color.  Generally, when new highways, truck routes, industries or other potentially harmful additions are planned, they are put in or near low income neighborhoods of color because they have less political power to fight against it.  Also, areas that have higher air pollution also tend to have lower housing prices.  To learn more about these disparities, check out the State of Health Website here.

School Lunches - an opportunity to improve health

What is the National School Lunch Program?

The National School Lunch Program (NSLP) feeds millions of children in schools every day. In 2012, 19.6 million children received free and reduced-price lunch, a qualification that is based on family income.

Source: http://www.fns.usda.gov/hussc/healthierus-school-challenge-tips-award-winners-get-started

Children with families at or below 130% of the Federal Poverty Level (FPL) qualify for free lunches (an annual income of $30,615 for a family of four).

Schools that chose to participate in the NSLP receive cash subsidies from the U.S. Department of Agriculture (USDA). For the 2013-2014 school year the reimbursement rates are:

• $2.93 for Free Lunches (each child’s lunch who is under 130% of FPL)
• $2.53 for Reduced Price Lunches (each child’s lunch who is under 185% of FPL)
• $.28 for Paid Lunches (each child’s lunch who is over 185% of FPL)

The National School Lunch Program Nutrition Standards

In January 2012, the Federal government issued updated NSLP nutrition standards. In part, the updated nutrition standards were in response to the rapid increase of obesity in children, particularly low-income children. Among low-income children, obesity rates increased 23% between 2003-2007, compared to a 10% increase among all U.S. children. Rates of severe obesity are roughly 1.5 times higher among poor children. For many of the children who receive free lunches, it is the only guaranteed meal they receive that day.Schools provide a great opportunity to impact childhood obesity. Not only are children required to attend school by law, but they also consume at least one meal five days a week at school.   The updated nutrition standards:

• Increase fruit and vegetables served
• Emphasize whole grains
• Allow only lower fat and nonfat milk
• Limit calories
• Reduce saturated fat and sodium

Source: http://healthymeals.nal.usda.gov/state-resources/build-healthy-lunch-reimbursable-meal-identification-system

Providing healthier items at lunch will at least provide many children one healthier meal everyday and that is a step in the right direction. However, I think the message and food environment in schools is more important than the actual nutrition quality. Kids learn by example and schools are a learning an environment. What are we telling our kids when they learn about the benefits of fruits and vegetables but in the lunchroom there is only pizza?

The Barriers to Providing Healthy School Lunches

As soon as the updated NSLP nutrition standards were released, many school districts nationwide expressed concerns. In September 2013, The Robert Wood Johnson Foundation and The Pew Charitable Trusts conducted an extensive survey of schools and the barriers faced while implementing the new nutrition guidelines. The barriers include:

1. Higher costs. It is too early in the new USDA school lunch guidelines to have data related to cost of school meals. Researchers disagree on the cost of fresh food compared to easy to re-heated, processed food. New research shows that a diet rich in fruits, vegetables, nuts, and fish costs about $1.50 more per person per day. If that increase in cost is applied to schools, it is substantial. However, there are innovative school lunch programs (listed below) that have proven it is possible to serve healthy meals on a budget. Another cost to consider is the increase in staff needed to cut, chop, and cook foods. If a school staff previously only reheated pizza, it is a large annual cost to hire more people in the kitchen. Schools are already cash-deprived.

2. Need to remodel or upgrade school kitchens. Many schools do not have full kitchens, but instead operate out of a district-wide central kitchen and deliver the foods to schools. This makes the preparation and storage of fresh foods difficult. For example nearly half of New York City schools lack cooking and fire-suppression equipment to cook on a stove and Seattle prepares all foods at district headquarters before being shipped out to schools. The USDA has strict rules for food storage for good reason, and, currently, many school districts do not have suitable kitchens.

Neat things schools are doing

Like I stated above, some innovative school have pushed past the barriers and are serving healthy lunches. Here are three examples.

1. Minneapolis Public Schools. In full disclosure, I am a product of the Minneapolis Public Schools (MPS) district, which is probably why I’ve been following their school lunch improvements. Many Minneapolis schools don’t have full kitchens so most of the food prep happens at a central nutrition center.  However, in 2012 the district hired Bertrand Weber who declared he was bringing real foods back to the schools. Since then Weber has banned irradiated meats, converted all high schools to cooking from scratch, set-up salad bars with seasonal ingredients, and focused on staff development. The menu for December looks great and certainly different from the meals I remember. Check it out here. Spoiler: the menu includes free-range turkey, arroz con pollo with brown rice, and thai red curry.
2. Baltimore School District. The Baltimore schools system was the first to implement meatless mondays back in 2009. Since then 18 school districts have followed Baltimore in instituting meatless mondays. The district also partners with local farmers and has a Great Kids Farm to teach kids about locally produced foods.
3. Farm to School Programs nationwide. According to the National Farm to School Network, there are 38,629 United States schools that have a farm to school program. Some schools have more extensive farm to school programs than others - from a day dedicated to farmers to school gardens. Earlier this year, Oregon awarded $1.2 million for Farm to School and School Garden Programs. A majority of the money will go to purchase locally grown foods to feed students with the remaining funds for education and gardens. Massachusetts is another example of a state with a vibrant Farm to School program. In the 2011-2012 school year, 231 schools and 114 farmers participated in the program.

The list above is short and there are endless examples of awesome things schools do everyday to provide healthy free lunches for students. Some people are convinced that kids aren’t going to eat healthier foods. Most kids like fruits and vegetables if they are prepared well and are the norm in their environment. School lunches are a huge opportunity to introduce new foods to children and unlike previous generations, the new foods should be healthy. Looking at the rates of obesity in this country, we have to provide healthier lunches, we have to teach kids what a normal lunch should be, and we have to provide the financial support to all school districts to do so.

World AIDS Day

Yesterday was world AIDS day so today’s post is in honor of all those who we have lost to HIV/AIDS and who are living with this disease.  If you are interested in finding out more about the virus itself, prevention, diagnosis, or living with HIV/AIDS, check out AIDS.gov which is run by the Department of Health and Human Services.

HIV/AIDS Worldwide

There are an estimated 35 million people living with HIV/AIDS worldwide, and though all continents and countries have suffered from this epidemic, low and middle income countries have been hit the hardest.  There is also a lack of access to prevention and treatment for the majority of those living with or at risk for HIV.   (Global Statistics - AIDS.gov)

HIV/AIDS in the United States

The CDC estimated that 1,148,200 people in the United States were living with HIV/AIDS in 2012 with about 18% of those people unaware of their infections.  Unsurprisingly, people of color are disproportionately affected by this disease.  Though 12% of the US population is black, 44% of people with HIV/AIDS are black and 44% of those newly diagnosed in 2012 were black.  Hispanics account for 16% of the US population but 19% of those living with HIV/AIDS and 21% of newly diagnosed cases.  

The Good News

We have made great strides when it comes to treating HIV/AIDS and in the last few years have even started hearing about people who may have been cured.  In Mississippi there is a child born with HIV who was given high doses of antiretrovirals almost immediately after delivery.  Two and a half years later, that child is functionally cured (this just means that the presence of the virus is so small that tests can’t detect it and treatment isn’t needed).  Since 2007, there has also been 3 adults who have been functionally cured of HIV/AIDS.  Timothy Ray Brown (The Berlin Patient) received a stem cell transplant in 2007 from a donor with a rare genetic mutation that is resistant to HIV infection and is still virus free to this day.  More recently, two men received bone marrow transplants that resulted in all traces of the virus disappearing within 6 to 9 months.  For most people living with HIV/AIDS, stem cell and bone marrow transplants aren’t worth the risk; however, these cases are advancing our understanding of the virus and hopefully leading us to a cure. (Patients HIV-free for now after transplant)

The Bad News

Austerity measures in other countries and sequestration in the US could stop our forward progress.  The US has long been the leader in biomedical research, but with sequestration, much of the funding for the National Institute for Health has been cut.  In fact, the NIH will lose $229 million in 2014 because of sequestration.  The means that 15,000 Americans will lose financing that helps them pay for antiretrovirals and 4,000 will lose housing support.  Again, these cuts will disproportionately affect people of color. (Sequestration 2014: Undermining the Response to HIV/AIDS in the US)

There is also the issue of the cost of antiretroviral drugs worldwide.  Pharmaceutical companies have done as much as they can to stop the creation of less expensive generic drugs in less wealthy countries (where the majority of HIV/AIDS sufferers live) which would allow many of those with HIV/AIDS to not only live with the disease, but also be less contagious.  The US government has unfortunately sided with the drug companies over the millions of people suffering from HIV/AIDS by threatening countries that do not honor patents with trade sanctions.  You may be thinking, “but the drug companies need to make a profit or they won’t do research and no one will be cured” and you would be right.  Companies do need to make a profit or they won’t continue creating drugs; however, last year, the top 11 global drug companies made $85 billion in profits - they can afford to make less.

Conclusion

In the words of Jonas Salk - founder of the first successful Polio vaccine - “there is no patent, could you patent the sun”.  For those who are living with HIV/AIDS, treatment is the sun.