Global public health development goals: Paul Farmer on who lives and who dies.

Global public health development goals: Paul Farmer on who lives and who dies..

Economics should never have sought to divorce itself from the other social sciences and can advance only in conjunction with them. -Thomas Picketty

A day late for World Health Day. I hope my prof won’t mind if I share an article from this week’s readings. It’s going to be a task to disentangle the social injustice from the ethics of access from the rageifying post-colonialist cut-and-run, then weave in a thread of third world problems here in the US, but hey I’ll do my best to analyze coherently.

I can’t tell if the article is unwieldy or if it’s just my feelings on the subject. Either way a worthwhile read.

Why the cops don’t get called for campus sexual assaults.

How does it make sense that universities are responsible for adjudicating sexual assaults on campus? Well, Title IX and US Supreme Court rulings dating back to the 1970s. Read the article, it explains the why and makes clear just how short UVA and others are coming up in complying with the mandate. Ugh.

via No, We Can’t Just Leave College Sexual Assault to the Police – Alexandra Brodsky and Elizabeth Deutsch – POLITICO Magazine.

What Alexander helped to establish, then, is that campus rape is not just a crime but also an impediment to a continued education—and to subsequent success in the workplace and public life. That means that Title IX’s protections are necessary for an individual student’s learning opportunities and for gender equality throughout American life. If sexual violence goes unaddressed at universities, women will face unconscionable obstacles to education, professional success and full citizenship.

 

Cholera Gave a British Doctor the Idea for IVs – The Atlantic

via Cholera Gave a British Doctor the Idea for IVs – The Atlantic.

WOO IV therapy! That’s my bread and butter! Hydration, volume expansion, insulin drips, antibiotics, everything you could want while unconscious. Plus just like in early days, it’s always there for a last ditch attempt. Coding? FLUIDS!

Also, science was much drunker before IRBs and we owe dogs so much apology and gratitude.

In 1656, Sir Christopher Wren wanted to see what would happen if he took a quill and a pig’s bladder and used it to send intoxicants—beer and wine and opium—directly into a dog’s blood. (The dog was intoxicated.)

Panic, Paranoia, and Public Health — The AIDS Epidemic’s Lessons for Ebola — NEJM

Panic, Paranoia, and Public Health — The AIDS Epidemic’s Lessons for Ebola — NEJM.

Please read this because we have to remember our history to learn from our history.

Various politicians called for quarantining of anyone who tested positive for HIV, and commentator William F. Buckley infamously penned an op-ed in the New York Times saying that “everyone detected with AIDS should be tattooed.”

Let us pump our collective brakes.

I mentioned in an earlier post that as an infectious disease, Ebola is a slam dunk for a country with a robust public health system. It poses far fewer challenges then, say, a really bad respiratory virus. This technically-but-really-not-an-epidemic has shown that there are some weakness in public health. Particularly in leadership. I’ll leave you with a parting tweet:

Falling into the gap.

Midsummer 2012 the supreme court upheld the majority of the provisions of the ACA, and people like me who had made every major life decision since turning 22 based on where I could get health insurance (hello preexisting conditions) breathed a deep sigh of relief, wept one tear, and took a long nap.

Fast-forward to now and the part of the decision that made it optional for states to decline to expand their Medicaid programs is taking it’s toll. In states where Medicaid was not expanded, the majority of adults making under 100% of the federal poverty level have no options for health insurance. They do not qualify for the incentives available through health insurance exchanges. They cannot afford private coverage. Unethical.

Just for fun, here’s the states by political party in 2013 (source):

governors 2012

Uninsured people will still use emergency departments and be inpatients, putting hospitals in a tough position as part of the ACA takes away the pre-ACA measure of DSH (disproportionate share hospital) funding (federal dollars) that hospitals needed to account for the absence of reimbursement from these uninsured folks. DSH dollars were supposed to be replaced by payments from Medicaid insurance dollars. In states that did not expand Medicaid, DSH dollars are being replaced by zero dollars. IMHO this is on the state–but Obamacare takes the knock. From the patients denied access to affordable care, the hospitals that are in dire straights financially, and the communities that are losing their hospitals (and often largest employers) as they just can’t stay afloat.

I’m working up posts describing how one qualifies for Medicaid in non-expanded states, the state incentives offered by Medicaid expansion, and the burden on local communities with large numbers of uninsured people in poverty. This is a mire, but I can’t think of one more worthwhile to wade through. PARTY TIME!