The Marlboro Man is one of the most iconic advertising images from the 20th century. The cowboy, depicted in some rustic setting, was single-handedly responsible for turning Marlboro’s annual sales from $5 billion a year to over $20 billion a year in the two years after the campaign was introduced. Since the success of that campaign, anti-smoking activists have tried several different ways to limit cigarette advertising. The latest salvo comes in the form of last week’s WHO statement on plain packaging, where they recommended plain packing as part of “comprehensive approach to tobacco control that includes large graphic health warnings and comprehensive bans on tobacco advertising, promotion and sponsorship.” Plain packing standardizes how cigarettes are sold, keeping the picture health warnings, but making the brand names, pack size, colour scheme all identical to limit their appeal.
2013 was a big year for public health. We were thrust to the forefront again with disease outbreaks, and have had to deal with increased skepticism of the nature of what we do from the public. Meanwhile, within the establishment, rifts have been growing between groups, as different professional organizations vie for power and control. Here are my top five public health stories for 2013, presented in no particular order, but I’d love to hear yours in the comments.
1. Polio in Syria
Polio is a crippling disease that has been covered on the blog before. It’s been almost completely eradicated, but is still endemic to certain parts of the word. However, following civil unrest in Syria, polio has started to spread again and has, to date, crippled 17 children. Before the March 2011 uprising, vaccination rates were estimated to be above 90%. However, since then, estimates for vaccination rates hover around 68% – enough to prevent the benefits of herd immunity from kicking in. In order to increase immunization rates, the UN is trying to mobilize a vaccine drive. However, due to political and safety concerns, they are having a hard time ensuring that all children are vaccinated. To quote NPR:
Polio does not stop at borders or military checkpoints. Without a comprehensive response to stop the virus, aid workers fear that the outbreak could become a public health catastrophe.
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In Canada, the top three causes of death for men are cancer (31.1%), heart disease (21.6%) and unintentional injuries (5.0%). The top two are the same for women, although with slightly different percentages: cancer and heart disease account for 28.5% and 19.7% of all deaths among women, with stroke (7.0%) coming in third. In the US, men die at an overall rate 1.4-times higher than women, of heart disease 1.6-times more, and are twice as likely to die from an unintentional injury.
In fact, women outlive men by 4.5 years on average worldwide – 66.5 years vs 71.0 years. This difference increase to 7 years in the developed world. Not only are men more likely to die from the causes above, men are also more likely to commit suicide than women. This gender difference increased following the recession. A time trend analysis from the UK found that approximately 850 more men, and 155 more women committed suicide than would have been expected based on historical trends following the 2008 economic downturn, with the highest increases in those regions that were most affected by rising unemployment.
But what leads to these outcomes? Given we live in a world where people can get help when they need it, why should men be dying at a rate that is that much higher than women for (almost) the same diseases? And why are they dying younger than women?
Last time I spoke to you about wording and public health, and the unintentional impact that can have on people. I want to continue on that theme today, and talk about what is perhaps one of the most pervasive, and more controversial language choices that we as as a society have made: the military language we use around cancer. Often, the media (and by extension, society) describe someone with cancer as a “warrior” who “battles” cancer. This language isn’t rare, and has been around since the mid-70s when Susan Sontag wrote her book “Illness as a Metaphor.” Research by Seale (2001) states:
News stories commonly feature sports celebrities with cancer, as well as sporting activities by ordinary people with cancer, designed to generate a sense of (usually successful) personal struggle.
I’ve made no efforts to hide my love for the CDC’s outreach efforts. Their YouTube, Twitter and Facebook pages are a great resource for Epidemiologists and lay people alike, and their innovative methods of engaging the public have been absolutely spectacular (see their Zombie Preparedness Guide for example). They’ve been incredible at embracing social media and are really pioneers in this area, including making a toolkit for those interested in using social media in their own organizations (link is a pdf).
As part of their outreach, the CDC does Twitter chats. This month the CDC has decided to focus on cervical cancer, and has uploaded a podcast about the disease, as well as a short fact sheet to prepare readers.
On Monday, January 30th at 2pm EST, the CDC will be using the #CDCChat hashtag on Twitter to host a conversation with Dr Tom Frieden, the CDC Director and MPH graduate from Columbia.
Following the discussion last week about Twitter and how it can be used by researchers, this is a great opportunity for those interested but not sure to try Twitter out. Think about it: How many times in your life will you get a chance to ask the Director of the CDC about cervical cancer? Or his views on decreasing screening rates for cervical cancer? Or whether he thinks Epidemiologists are most like Sherlock Holmes, Batman or Nancy Drew/The Hardy Boys?
Let me know if you take part!
Mr Epidemiology 