Peapod: A Means for Food Justice

November 23, 2010

I admit that I have done little research before writing this post, but there is an idea that I’ve been thinking about a lot recently and may update over the next week:

The Peapod grocery delivery service could end access-related food security issues in the urban United states.

For those of you that don’t know about Peapod (i.e. for anyone that, unlike New Haven, actually has a nearby grocery store) – it’s a grocery delivery service run by Stop and Shop. You can order just about anything that Stop and Shop would usually have in their grocery stores and all your groceries will be delivered to you in plastic bags, often within 24 hours (you can pick a 2 hour delivery time window)

You can buy everything: milk, meat, fruit, vegetables, cheese, coffee, spaghettio’s, marshmallows, beer, and even items outside the common graduate student’s diet. I’ve used Peapod for a few months now and have been really happy. Others claim that bananas show up brown or the lettuce goes bad quickly. Regardless, it has made life a lot easier for me: a graduate student without a car and limited food budget.

The public health implications of this service are incredible. Low-income families often suffer in a automobile-dominated society. If you don’t have a car, you can’t drive to the grocery store. Low-income neighborhoods aren’t a great market for big supermarkets, so you don’t find many Whole Foods in inner-city Detroit. These “food deserts” are becoming a major social problem and were recently featured by a  New York Times Magazine article:

The term is generally used to describe urban neighborhoods where there are few grocers selling fresh produce, but a cornucopia of fast-food places and convenience stores selling salty snacks.

Food injustice” has become a buzzword term featured in several articles to discuss the disparities that exist in the US regarding the access to groceries:

If you don’t have access to groceries, you don’t have access to healthy foods, and therefore you don’t have access to proper nutrition. In case you haven’t read a newspaper in the past ten years: obesity is a pretty massive problem in the US, particularly affecting low-income families. If you can improve access to fresh produce, you can improve diets, you can improve health (or so the arguments goes).

Clearly, Peapod isn’t a perfect solution:

  1. There is a delivery cost that might make grocery delivery financially unavailable to the low-income families that need access to groceries. Government subsidies (or Stop and Shop philanthropy) could make this a non-issue.
  2. Without education, access means nothing. If you have access to all these new healthy foods but just buy beer and marshmallows, your health probably won’t improve (though apparently a twinkie diet can make you a lot healthier).
  3. Rural areas are still kinda left in the dust. Peapod’s grocery delivery probably is not a cost-effective way to improve access to foods to the boondocks.

But there is still a lot of potential.

I think there is an ideal pilot project here somewhere that combines:

  • food stamps
  • Peapod promotional materials
  • education materials regarding diet (including quick, cheap meals cookbook)
  • some kind of subsidy to cover delivery costs

Someone make it happen.


Top 5 Public Health Jobs (that have nothing to do with public health)

September 20, 2010

For a long time, I’ve had an idea for a post that I never fully developed. Finally, I’m going to post it. Perhaps some of the potential insights are only partially percolated in the post; regardless, we proceed.

To me, the question “How can I save the world?” always seemed to imply “How can I help the sick? How can I make people live longer, happier lives?” I’m not sure if this is a common association, but an enormous amount of impact can be made through broadly improving public health.

Almost all of the world’s greatest tragedies are issues of public health. While the discipline often focuses on disease epidemiology or health policy, other major events clearly affect the health of populations: war, climate change, mental stress, natural disasters. Objectively, public health is not just vaccinating children but bringing conflict resolution, preparing for hurricanes, improving family dynamics, paving roads, building bridges (physical and metaphorical), and improving the quality of life for large numbers of people.

Unfortunately, such a broad scope can’t really be covered in a Masters program. Instead, we learn biostatistics and memorize long lists of risk factors for cancer, infectious disease, and other behaviors that lead to sickness. (It turns out, being really poor makes being healthy really difficult).

All of these many health-related disciplines, however, need leaders. And since getting an MPH can slow people down for two years, I’ve compiled a personal list of the top five occupations that I believe achieve the most public health (i.e. save-the-world) impact.

1) Teachers
One of the most impressive correlations that exists (in my opinion) is the correlation between health and education. From a 2007 NY Times article:

The one social factor that researchers agree is consistently linked to longer lives in every country where it has been studied is education. It is more important than race; it obliterates any effects of income.

Education improves the economy, decreases risky behavior, and even cuts down smoking; not to mention the vocational training in finding stable employment and improving the economy.

2) Engineers
According to charity:water, unsafe water and lack of basic sanitation cause 80% of diseases and kill more people every year than all forms of violence, including war. The social consequences are equally destructive:

In Africa alone, people spend 40 billion hours every year just walking for water. Women and children usually bear the burden of water collection, walking miles to the nearest source, which is unprotected and likely to make them sick.

Time spent walking and resulting diseases keep them from school, work and taking care of their families. Along their long walk, they’re subjected to a greater risk of harassment and sexual assault.

In many places, water is hard to come by. There needs to be water infrastructure and to create this infrastructure we need innovative engineers. Plain and simple.

Engineers have done a lot to help the world. From the CBS Business Network:

Engineers have built more than 36,000 large dams around the globe to control floods and provide hydroelectric power, irrigation, industrial supplies, and drinking water to an expanding population and economy.

3) Politicians (kinda)
Poor governance in low-income countries ultimately causes A LOT of global health problems. Poverty becomes exacerbated. Public interventions fail due to corruption. Private markets cannot be efficiently regulated and open the door to exploitation.

Maybe Wycleaf Jean had the right idea on how to help the poor: become a politician.

Admittedly, although many problems are caused by governance, I don’t know that being a non-corrupt, intelligent, or even musically talented politican is the best way to overcome the problem. Bureaucracy, international relations, and other social, political, and economic dimensions discussed in a long list of Yale seminars aren’t easily solved by one Senator’s voice.

But hopefully there will always be people like Nelson Mandella, John Adams, Ellen Johnson Sirleaf and others to prove me wrong.

4) City Planners
There are more people in the world that face obesity than malnutrition. When I first heard that I was amazed. Now, admittedly, it makes sense.

Coined the “obesity epidemic,” a epidemiological transition has led to heart disease, cancer, diabetes, and other BMI-related chronic diseases to (appropriately) take the foreground in Western health policy. (In just about every public health class I have ever taken, obesity is one of the first issues that is discussed).

What can be done to prevent obesity? There are lots of alternative ideas being thrown around: sugar taxes, gym subsidies, improved health education, high quality healthy foods in low-income neighborhoods. All have potential, but one area that needs more emphasis is city planning.

To improve food security, encourage walking, and get people out of the BK breakfast->cubicle->episodes of Lost->bed routine, we need city designers.

In New Haven, I ride my bike or walk everywhere. I have access to nearby healthy foods and a gym. I have groceries delivered to me from a nearby grocery store. (Incidentally, grocery story delivery man could deserve an honorable mention for this list: finally, a way to maybe get produce and fruit to low-income neighborhoods).

By creating cities that can be navigated on foot (with efficient transportation) instead of relying on cars and highways, urban planning can create metropolitan hubs that have improved access to healthy foods while increasing exercise and even decreasing a reliance on (economically- and environmentally-) costly vehicles.

5) Journalists
I like to think I’m an idealist and an optimist. Yet, I get overwhelmed with global problems and discouraged trying to make an actual difference. It is during these times I consider dropping out of school, becoming a Park Ranger, and leading a content life in the wilderness. Or, investment banking.

Despite basically focusing on many of the world’s greatest tragedies, journalists like Nicholas Kristof inspire me and get me back on track. In order to truly address the plethora of public health issues (whether germs, genocide or gender inequality), we need to hear about them. Journalists bring these issues into the spotlight. They inspire. They mobilize. They tell people about the enormous disparity and they recruit the future leaders that will devote their lives to ending them.

Oprah can mobilize a social movement. Ben Franklin used journalism to influence the American Revolution. Glenn Beck can (unfortunately) get millions of people to hang on to his every word. This is a powerful tool to create enormous shifts in our world. Unfortunately, the economic future of journalism remains uncertain so it probably won’t pay that well.

At least there are always blogs.

Acumen Fund: Training the Next Generation of Leaders

July 28, 2009

Earlier this summer, 17 students from across the US and around the world came together in New York City to talk about one thing: social entrepreneurship. I was privileged to participate in the Acumen Fund‘s inaugural Student Leaders Workshop and the experience was insightful, exciting, and humbling all at once.

While the workshop focused on poverty alleviation and development through “patient capitalism,” many of the lessons I took away from the program have significant implications for all things public health. (It seems, after all, the more public health courses I take, the more I recognize the importance of well-structured, well-managed, sustainable interventions that truly address the needs of the people served.) The solution? More focus on market mechanisms.

While market mechanisms may not work for everything (read: health care in the US), there is definitely something to say for the empowerment of the underserved by supporting a long-lasting business economy, not providing charity and aid alone. Organizations like Kiva, Ashoka, Skoll Foundation, Echoing Green, and Acumen Fund are recognizing the potential for growth, and “social returns” in a new and emerging market populus: the poor. By targeting the “base of the [economic] pyramid,” companies can find new opportunities for profit while including underserved populations in to the global economy. And not just as consumers, but producers too. It’s worth looking up if you haven’t done so before. Check out #socent on Twitter if you really want to see what’s going on.

Our student group was also fortunate enough to hear the enthusiastic words of buisinessman marketing guru, best-selling author, and activist Seth Godin. He offered a lot if interesting wisdom and a challenge to young students to fight against the status quo and truly make a difference in the world. One of his pearls worth listening to: “Don’t go to medical school.”

The group of passionate, out-spoken, intelligent students (of whom I came across clearly by mistake) came to the workshop each offering their unique skills, vision, and ideals. Each left with enthusiasm to continue the work of creating positive social change and each left with a determination to continue the push for a social movement to end global poverty.

Currently, the group is working on developing a new product that will help spread awareness for the ideas of social entrepreneurship in bringing about change in poverty alleviation, health, and sustainable energy. Additionally, a viral film is in production to bring people together from all over the world to see what changes can be made through social enterprise (Find out more here or get involved here)

Let’s get to work.

What Zombie Movies Can Teach Us About Public Health

July 21, 2009

I’m going to commit a no-no. Bloggers are probably not supposed to re-post articles from the past, but that’s exactly how I’m going to start off.

As a public health student and a zombie enthusiast, this Op-Ed for the Yale Daily News combined two of things I love most. With an virulence rate of 1.00 and fatality rate of 1.00 (or 0, depending on how you look at it), zombism is a public health worker’s worst nightmare.

Originally printed in the April 8, 2009 Opinions section of the Yale Daily News.
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Berk: Zombie movies can teach us

By Justin Berk

Is Yale prepared for a zombie attack?

After wasting hours of time studying for tests, writing senior essays or building Styrofoam dinosaur dioramas, many students forget to focus on the inevitable zombie apocalypse. Once the crisis hits, where will the unprepared student body turn? The political science majors are too soft, Directed Studies freshmen are too inexperienced and those math kids will probably just stay in the library working on problem sets. Who can possibly be our zombie saviors?

Enter public health enthusiasts.

If you’ve ever seen a zombie movie, you’ve seen an introductory guide to public health. The flesh-eating undead are an epidemiologist’s worst nightmare, but they can teach us a lot about public health crises and begin a philosophical discourse on the trade-offs between individual liberties and public safety.

Whether students learn them from an HIV surveillance internship or from watching “The Evil Dead 2,” there are four vital public health themes that everyone should know.

First, epidemics can strike at any time. Whether caused by medical experimentations of the rage virus (“28 Days Later”), pollution of 2-4-5 Trioxin (“The Return of the Living Dead”) or unusual moon alignment (“Night of the Living Dead”), a virus can appear quickly and spread rapidly. Without adequate resources, preparation or knowledge of the disaster, uninfected individuals face a heavy disadvantage compared to those who understand the risks of disease. Educational public health warnings are important. Pay attention next time: Get a flu vaccine.

Second, the medical model doesn’t have all the answers. In today’s health system, almost all health funding goes toward treatment of illness instead of prevention. This is an inefficient way to deal with cardiovascular disease, and an inefficient way to deal with proliferation of the undead. There’s no cure for zombie-ism, just as there is no absolute cure for diabetes or HIV (there are, however, life-saving treatments for both of these diseases). Prevention is key and must receive greater priority when looking at the health policy issues today.

Third, public health is an interdisciplinary field. Broad epidemic preparedness requires work from all academic disciplines from epidemiology to sociology, from medicine to economics. The economic efficiency of vaccine delivery, the morality of community quarantines, the anthropology of disease and the construction of wooden barricades are all important issues that come up during a health crisis such as a zombie attack. Disease — whether caused by a stomach bug, biological attack or brain-devouring syndrome — rarely has a magic-bullet cure. Instead, a coalition of experts must provide new perspectives to new problems. Going into the consulting industry after graduation? Public health experts can still use your help!

Fourth, disease is a global issue and affects everyone. Pathogens ignore national borders. They are able to cross the world in hours or days; no country is invulnerable to the importation of disease. Additionally, pathogens can adapt to changing ecological environments, creating strains resistant to basic treatments (the infected in “I Am Legend,” for example, began as allergic to sunlight, but by the end of the movie could venture into the dusk-time shadows). Around the world, the improper delivery of medications for tuberculosis and HIV has already created such resistance. All demographics — whether poor or rich, local or distant — must have access to effective health care treatment and prevention programs to prevent the global spread of these resistant “superbugs.”

Other important life lessons abound in zombie films: Always keep your doors locked; it’s a good idea to have some canned food around; in general, avoid malls; don’t bro out too long with your buddy who just got that zombie bite.

Is Yale prepared for a zombie attack? Probably not. But public health experts constantly fight to prevent such epidemics and, when they occur, work diligently to recognize, isolate and cure any infectious disease.

So how can you become one of these champions of global health? How can you better understand the epidemiological principles that serve as a foundation of a healthy population? How can you learn to protect yourself from outbreak, starvation, or your infected residential college master charging you while you’re cornered against a fence?

Go watch a zombie movie.