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Why the average american hates the idea of "universal access" to anything
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I think I’ve figured it out. There’s something in public health called the “prevention paradox”: measures of disease prevention that offer great benefits to populations at large (such as fluoridation of water sources, wearing seatbelts, lifestyle changes, smallpox vaccinations, etc) offer little benefit or personal incentive to individuals.

But research shows that health education geared toward individuals (counseling on reducing salt intake for hypertension, exercise for diabetes, etc) are less effective when geared only toward individuals and/or used in a short-term approach. People are motivated to act for immediate gain and substantial personal benefits, but “the medical motivation for health education is inherently weak. Their health next year is not likely to be much better if they accept our advice or if they reject it. Much more powerful as motivators for health education are the social rewards of enhanced self-esteem and social approval.” (Geoffrey Rose, Sick Individuals and Sick Populations.)

Physicians also prefer individualized health education because with population interventions (such as anti-smoking campaigns), their success rates are low and results take a long time to achieve.

The US is such an individual-centric society that people have no cultural reason to care about population health as a whole. Most Americans do not see that universal access to healthcare means that problems are detected and treated early (which is less costly), and that sometimes preventive medicine can encourage life-saving behavior change. That the person going into the ER for stomach pain because s/he does not have health insurance is costing the taxpayer literally thousands more dollars than s/he would if s/he’d gone to a primary care physician.

Nor do they understand the concept of herd immunity- if a large proportion of a population is immune to or vaccinated against a particular disease, the likelihood that one individual will get that disease is far less.

The focus on the individual and the apathy toward the well-being of communities and populations is by no means restricted to health alone. The same can be said about the current financial crisis. Individuals who borrowed more than they could pay back, and their unscrupulous lenders have created a global downward spiral of hundreds of economies, with the bottom billion hit the hardest.

I find it ironic and deeply saddening that 30 million more people have been pushed into starvation thus far due to the financial crisis while bankers are taking hefty bonuses and governments are bailing out businesses that were failing even before the crash (GM, Chrysler, etc…)


May 18, 2009 | 4:09 PM Comments  1 comments



my letter to the editor of the Economist- Global Gag Rule and Obama
Translations available in: English (original) | French | Spanish | Italian | German | Portuguese | Swedish | Russian | Dutch | Arabic

maybe it will get published... here's hoping! :)


Sir,

I find it inaccurate to call President Obama's decision to end the Global Gag Rule, an "order... ending the prohibition on sending aid to international organisations that provide abortion." (Brief Encounter, January 31st). Obama's decision does not change the fact that US tax-payers' dollars cannot be used to provide abortions overseas. The
legislation, first enacted by Ronald Reagan, rejected by Clinton and reinstated by Bush, prohibited US family planning assistance to organizations that use non-US funds to perform abortions (even in countries where it is legal), provide counseling and referrals for abortion, and lobby to liberalize abortion laws.

None of these restrictions would be permitted within the United States, where abortion is legal. Yet US ideologues had no qualms about denying poor women the right to decide when and if to carry out a pregnancy. Each year there are 19 million unsafe abortions, most of which could be prevented if poor women had access to voluntary family
planning including contraception, sex education, and the ability to prevent unwanted pregnancies. In addition, women with fewer births are able to invest more in their children's nutrition and education-- resulting in healthier, more productive contributors to society.

Many of the organizations that lost their funding were unable to provide other life-saving services such as maternal and infant healthcare, poverty reduction, and HIV prevention. For example, the United Nations Population Fund lost its US contribution of $244 million over seven years, based on a spurious claim of collusion with the Chinese government in coerced sterilizations. This contributed to 74,000 deaths from unsafe abortion globally each year, even though Bush's own hand-picked State Department team visited China and found no evidence that UNFPA participated in such programs; and, indeed, that its programs were "a force for good." Obama's move to restore reproductive freedoms to women will surely reduce global demand for abortion and improve overall population health.



(PS- the picture of all the old white dudes is from bush's second day in office, when he signed the global gag rule back into its miserable existence.)

February 3, 2009 | 10:37 PM Comments  0 comments

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AIDS Sutra: Untold Stories from India
Related to country: India

Translations available in: English (original) | French | Spanish | Italian | German | Portuguese | Swedish | Russian | Dutch | Arabic

(Written for SAWNET, http://sawnet.org/books/reviews.php?Aids+Sutra)



Today there are approximately 3 million Indians living with HIV and AIDS, a number that masks the human faces behind a disease that has been reviled and misunderstood as the worst plague in human history. A disease often considered to afflict only those regarded as the dredges of society, AIDS has the potential both to expose the dark underbelly of society, and also to inspire triumphs of human compassion and perseverance.
AIDS Sutra, funded by the Gates Foundation, is a compilation of 16 vibrant essays about Indians living with HIV by some of South Asia’s most gifted authors, including Salman Rushdie, Vikram Seth, and Kiran Desai. Several of the essays are narrated directly from the authors’ home communities; others are the fruition of their travels to the vastly different regions of India.

Siddharth Deb’s poignant account, “The Lost Generation of Manipur,” brings him to a remote corner of India bereft of employment opportunities and constantly on edge due to communal violence. Uncontrolled injecting drug use in the region puts young people of working age especially at risk for HIV infection.

Salman Rushdie’s piece on the politics and culture of the hijra (intersexed and/or transgender) community is a concise account of a population that defies society´s common [mis]perceptions around gender and HIV risk. Rushdie interviews a transgender AIDS activist named Laxmi, who lives in a constant duality of gender- going as a man by day and living with her parents, and transforming into a woman at night and on the weekends. Her advocacy on behalf of this distinct community in India has helped to distinguish hijras as a third gender- with different needs and challenges than men who have sex with men.

Other stories included in the book examine the lives of truck drivers, sex workers, and devadasis, women traditionally given to god, and nowadays women who choose or are forced into sex work as a means of income generation. In Sunil Gangopadhyay’s essay, “Return to Sonagacchi,” the author returns home to Kolkata to compose a compelling account of the lives of sex workers in Sonagachhi, narrating both the deprivation they face and also their power as an organized movement fighting for their rights as sex workers to safety, health services, education for their children, freedom from police persecution, and dignity.

Bill and Melinda Gates give the anthology’s introduction, and its insightful forward is written by the Nobel Prize-winning economist and author of Development as Freedom, Amartya Sen. Sen revolutionized the traditional economic paradigm by asserting that development is not simply about increasing per capita income, but rather “a process of expanding the real freedoms that people enjoy.” His examination of the economic effects of AIDS in India is nuanced in its consideration of both the beneficial impact of Indian pharmaceuticals in producing affordable antiretroviral drugs for much of the world, and the irony that income disparity in India prevents the majority of Indians living with HIV from accessing treatment, quality medical facilities, shelter, employment opportunities, and community support.

Sen argues that stigma is the primary fuel of the epidemic in India, where widespread ignorance pervades about how HIV is—and is not—transmitted. Among young Indians just reaching working age, knowledge how HIV is spread is dismally low at 25% of the population according to UNAIDS (20% comprehensive knowledge among women and 36% among men). Because many Indians still believe that HIV can be transmitted through touch, sharing food, or through aerosol transmission, Indians living with HIV face discrimination in schools and workplaces, ostracization, rejection from their families, and in many cases, violence and even death.

India’s uncomfortable and often times paradoxical relationship with sex and sexuality is often at the root of ignorance and discrimination against HIV, with 87% of new infections in India occurring through unprotected sexual intercourse each year according to India’s National AIDS Control Organization. Despite an ancient culture rich in celebration of natural human sexuality, imperial-era taboos surrounding sex continue to create a stifling conservatism that limits access to scientific information about sexually transmitted infections, reproductive health, and the rights of women and sexual minorities.

In Amit Chaudhuri’s essay, “Healing,” he remarks that “The troubling ambiguity of sex through history— the fact that it bestows life and pleasure, and also, in a way that can’t be entirely explained by morality, confuses and shames— have converged in a new way upon this disease.” His interviews with Alka Desphpande, an AIDS researcher and physician in India’s first AIDS ward, reveal the challenges faced even by the medical community in becoming educated about HIV. Large numbers of Indian health care workers still believe that HIV is transmitted by touch, and widespread denial of treatment and discrimination against people living with HIV is common.

The first essay “Mister X Versus Hospital Y” by Nikita Lalwani tells the story of a Dr. Tokugha who is infected with HIV and becomes an important activist when his results are disclosed to his family (and bride-to-be’s family) before he himself is made aware of his status, just days before the wedding. His lawsuit against the hospital’s breach of his privacy sparked controversial debate and the release of his name in newspapers all across India. The court ruled against him, “decreeing that the hospital’s release of the information to the minister without his consent had ‘saved the life’ of Toku’s proposed fiancée. The essay forces us to consider the complexities behind forced disclosure of one’s HIV status. Not only was Dr. “Toku”’s right to self-disclose taken away from him, the judge tacked on a devastating addition to the ruling, that suspended the right of HIV positive people to marry. The laudable human rights organization, The Lawyers’ Collective, fought for years to restore this basic human right to people living with HIV, succeeding in 2002. Since then, Dr. Toku has become a prominent physician in the field, and goes above and beyond by arranging matches between people living with HIV.

Discrimination and national legislation intersect most brutally in India with the penal code provision 377 that makes homosexuality a criminal offense. Drafted in 1860 during British Rule, the anachronistic law fines and imprisons Indians caught in the act of sodomy and even oral sex for between ten years and a lifetime in jail. The law has served to drive homosexuality “underground” where men having unprotected sex with men cannot be reached for HIV awareness raising, sexual health services, STI screening, or recourse for police persecution and demanding of bribes.

One story included in the collection was strikingly disappointing— to the point of giving offense. Shobhaa De’s “When AIDS Came Home” reveals the author’s ignorant, discriminatory and classist lack of understanding of HIV and AIDS. Her account of how her driver becomes infected with HIV and gradually dies from AIDS is peppered with comments about her “repulsion” that he had spent so much time with her children, speculations about his involvement with sex workers and his sexuality, and self-congratulatory accolades when she provided occasional money for a doctor or medicine.

De’s piece examines her misconceptions about AIDS and vaguely suggests that she has seen the error in her was (perhaps simply because it would not be politically correct to admit otherwise), but still fails to include what lessons she has learned. Indeed, to conclude her story Shobhaa marvels that “Although they are such an intimate part of our lives, how little we really know about the people who work for us… it took Shankar’s death to see him as a human.” She concludes by lying to her children and telling them that the driver was infected through a blood transfusion because the reality that many men purchase sex is too shocking to bear.

By far the most thought-provoking inclusion in the anthology, Siddharth Dhanvant Shanghvi’s “Hello, Darling,” diverges from the book’s overall focus on more “marginalized” populations of sex workers, drug users and truckers, to recount the life experiences with HIV of an upper-class homosexual film director whose pseudonym is given as “Murad.” Openly flamboyant, driven to success, and yet still slow to “come out” about his homosexuality, and later, HIV status, Murad escapes the confines of Bombay and moves to New York City. He is unable to move in the local film circuit and returns to Bombay years later, where he eventually succumbs to AIDS.

Shanghvi’s piece is particularly well-researched and deeply-felt; his account considers early chronicles of the impact of AIDS on art and artists in Edmund White’s “Esthetics and Loss,” and the strange phenomenon of how AIDS “got noticed,” as explained in Urvashi Vaid’s “Virtual Equality,” in which she observes “how the passing of an entire generation from AIDS helped give rise to the modern idea of homosexuality: thousands of men had to die, in fact, to have to be seen as alive in the first place.” Shanghvi’s inclusion was particularly important and contrasted sharply with De’s story. “Hello, Darling” should serve as a wake-up call to elites believing in their infallibility, since the risk behaviors that propel the spread of HIV in India are by no means limited to lower socioeconomic echelons of society.

Overall, the anthology is an important, moving, and transformative read. Each story is relatively brief and gives a taste of the authors’ diverse and prolific literary talents. Some tales, such as De’s, are clearly geared toward upper class Indians who are beginning to understand the complexities of the AIDS epidemic in India. Still others delve into economic, political and human rights aspects of the disease. Till now, literature and artistic works on AIDS in India have been limited and relatively unknown. AIDS Sutra gives voice to communities and individuals that have been destroyed, silenced, affected and transformed by AIDS in a jarring and yet deeply meaningful manner.

November 28, 2008 | 2:42 PM Comments  0 comments

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Iraq & America's Recession
Translations available in: English (original) | French | Spanish | Italian | German | Portuguese | Swedish | Russian | Dutch | Arabic

Wow. I was out of town for a couple days and come back to find Obama taking the lead, with Hillary's campaign manager and deputy manager resigned! McCain has promised no new taxes for his entire campaign, this just as the recession is looming, and the taxes in April will bring in less revenue than in years. The sub-prime mortgage crisis was not just a poor people's phenomenon- this type of behavior, of borrowing far more than one could ever expect to pay off, pervades the highest levels of government!


I have mixed feelings about MoveOn.org, but I really admire their new campaign "Iraq/Recession". They have a nice new email action that allows you to easily and automatically write an op-ed to your local newspaper (they send it, you write it) making the tie between the American recession and the Iraq spending. (A tie that is obvious, but few people actually realize!)


Some interesting facts:

"As of today, we've spent over $495 billion in Iraq.1 With the economy in the tank, think about what that money could do here at home: Cover millions of kids who don't have insurance, or help folks who're losing their jobs and homes.

Instead, it's supporting a failed occupation in Iraq.

More and more Americans are making the connection between the billions we've spent over there and the crumbling economy here at home. In fact, a new AP poll shows that most Americans think ending the war is the best way to help the economy.2 But pundits still talk about the war and the economy as two unrelated things.

* The recession is going to force states to cut back their budgets. Most likely, the cuts are going to affect the services that working families need and depend on.3
* Meanwhile, the war is costing Americans more than $338 million a day. 4 That money could be spent to help out the folks who're hurting most now. For less than what we're spending on the war, we could pay for affordable housing for hundreds of thousands of families, health care for children, or scholarships to help folks pay for education. 5
* Gas prices are close to double what they were before the war began. The cost of oil is still hovering around $100 barrel. 6
* We're borrowing $343 million every day to finance the war in Iraq. 7 Our skyrocketing debt will be a bigger and bigger drag on the economy—slowing recovery and burdening future generations.


Write an Op-Ed

If thousands of us write, we can get the media to stop ignoring the connection between the war and the recession. The opinion pages are the most widely read pages in the newspaper, so we can also make sure voters—who are growing increasingly concerned about the economy—know that any candidate who wants to stay in Iraq has no plan for the economy."


February 19, 2008 | 1:01 PM Comments  1 comments

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Jesus' Halo

Gone are the days of boinking creatures on the head in Super Mario
Brothers. Today's popular games are all about gruesome murder and
violence.

I had the lovely experience of playing Halo, a video game which,
thankfully, I am terrible at, which involves killing people with guns,
lasers, nail-spewing killing machines, and other highly effective and
incredibly scary weapons. When you kill someone, your entire
controller shakes and vibrates much like, I imagine, a real machine
gun would do.

I can understand why this game is so popular with soldiers in Iraq and
Afghanistan. It must help them to dehumanize their colonial subjects,
and normalize the experience of killing. I can also see why it's
popular with American teens, who are inundated with graphic violence
through movies, television, and news networks. Ultimately it will lead
them to sign up, to "die for their country" and maybe kill off a few
Muslims here and there to boot.

To the point-

It seems the Church thinks this is a wonderful way to attract young
people to the church, and, in their words, to promote "fellowship."

Whatever happened to "Thou Shalt Not Kill"? Is non-violence pass??


New York Times
NATIONAL | October 7, 2007


Thou Shalt Not Kill, Except in a Popular Video Game at Church

By MATT RICHTEL
Ministers and pastors desperate to reach young congregants are
using an unusual recruiting tool: the violent video game Halo.

October 11, 2007 | 8:20 PM Comments  0 comments



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