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Determinants of health

Five for fighting, three to six for mumps: Controlling disease outbreaks in the NHL (Part 1)


Editorial note: This piece was co-written by Atif Kukaswadia, PhD, and Ary Maharaj, M.Ed. Atif is a writer for the Public Health Perspectives blog on the PLOS network, and Ary is a writer for Silver Seven, an SBNation blog about the Ottawa Senators hockey team. This piece is being cross-published on both platforms. Enjoy!

INTRODUCTION

When we think of places for disease outbreaks, a few examples quickly come to mind: classrooms, college dorms, crowded trains. Another suggestion? The confines of the National Hockey League, where players are surrounded by literal blood, sweat, and tears. When you watch a hockey game, you’ll routinely see players spitting, swapping saliva through the sharing of water bottles, sweating — either through playing the game, using the same towel to dry themselves off, or rubbing their sweaty glove in another player’s face during a scrum. Add to this the intense travel and training schedule, along with the close quarters players are in between games, and this means that, among other things, the NHL is a breeding grounds for illness, even rare ones that do not generally permeate the public sphere.

 

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Jimmy Kimmel’s emotional monologue about his newborn son’s heart surgery

“I have a story to tell about something that happened to our family last week.”

With those words, Jimmy Kimmel opened his show. Using a combination of vulnerability and humour, he told us about the last two weeks in the Kimmel household, starting with the birth of his son: William “Billy” Kimmel. A few hours after the birth, a nurse noticed that the baby had a faint heart murmur, and was slightly blue. The baby was taken to Children’s Hospital Los Angeles, where doctors performed an operation to repair his heart (the first of several such surgeries Billy will need over his life). Thankfully, the surgery was a success, and Billy is now at home with his family, where both mother and baby are recovering.

Kimmel used this moment to express his gratitude for the healthcare workers who helped him and his family, thanking the nurse who first noticed the issue multiple times by name (Nanush Shakernia – “if it was a girl, we would have named her Nanush, we really would have.”), as well as the physicians, nurses, and healthcare professionals involved in his care.

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2017: What can we expect?

Following up from the end of last year, I thought it would be fun to predict what I think the next 12 months will have in store for us. So lets get to it!

1. Repeal of the Affordable Care Act

President Trump has already made it clear that this is one of his first priorities when he assumes office. The groundwork was already laid with the combination of the Senate passing a budget measure that was supported by Congress, and this week Trump issued an executive order to start rolling back the ACA. Now, the ACA is not without fault as we’ve discussed before; premiums have increased for many users, and the lack of true, universal coverage means many who don’t need coverage would rather pay the penalty than enrol. But repealing it without a replacement could be a disaster for many Americans. The Washington Post estimates that the repeal will kill more than 43,000 annually (based on this study in the NEJM). The impacts will be felt beyond the healthcare system though, with evidence from California suggesting that such a move could affect everyone involved with the health industry ranging from hospitals, food, and transportation services that all work together to provide patient care. Estimates from this study suggest up to 209,000 people would lose their jobs, and it would cost California over $20 billion dollars. It remains to be seen what replacement is offered, but the transition between the two is one that needs to navigated delicately.

 

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The only way to save Obamacare is to expand it

The Affordable Care Act was a landmark piece of legislation for the United States. While most other G-20 countries already have some form of universal healthcare (either through a single payer system, or mandatory insurance coverage), the US was one of the few countries that did not have one. Arguably, however, it didn’t go far enough, and therein lies its biggest problem.

One of the key provisions in Obamacare was that insurers could not deny coverage based on pre-existing conditions. This was a hugely important for those with serious or chronic illnesses, who would normally be denied coverage. For example, diabetes can cost someone approximately $7900 a year in direct medical expenses, which is a hefty sum if you don’t have insurance coverage. Obamacare mandating that these individuals, and others with similar conditions, have to be able to purchase coverage, is an excellent step forward. However, the business of insurance relies on those who enrol but do not require services subsidising those who enrol and do. In terms of healthcare, this would be low risk people paying and not using services, ensuring high-risk individuals are able to access services. As you can imagine, there is very little incentive for low risk individuals to enrol; a phenomena known as “adverse selection.”

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Basic Income: From an idea to reality

Our current way of dealing with poverty is inefficient at best, with mountains of forms, paperwork, weighed down by bureaucracy and procedures. At worst, it’s stigmatising and judgemental, keeping people in poverty rather than giving them opportunities to break free and elevate themselves out of poverty. One possible solution is providing individuals with a Basic Income (click link for my previous post on the subject).

A selling point for Basic Income is that it can save the government money. By streamlining select government services into one agency, it can reduce inefficiency. In fact, this is something that people on both sides of the political spectrum can agree on – both those who want small government and those who want the government to support our most vulnerable citizens. One example is in Ontario, where a recently published report titled “Finding a Better Way: A Basic Income Pilot Project for Ontario” by Hugh Segal reported that a basic income guarantee would replace Ontario Works and the Ontario Disability Support Program, giving everyone an income of $1320 a month, with an extra $500 for those with a disability. This would effectively replace those two programs with one larger, more comprehensive program that doesn’t require the same intensive oversight and monitoring.

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Which diseases do we get to “fight”?

About two weeks ago, the Hospital for Sick Children, also known as SickKids, launched their new ad campaign. For those who aren’t from Canada, SickKids is based in Toronto, Ontario, is the second largest children’s hospital in the world, and does some truly amazing and inspiring work. I highly recommend watching the ad, as the messaging and production quality is absolutely amazing. The imagery and symbolism is strong, and shows these children as fighters who will vanquish their foes. It shares more in common in terms of tone and imagery with NBA and NFL commercials than typical hospital advertisements.

I have mixed feelings on this ad campaign. On the one hand, it is meant to provide a strong, motivational message to children undergoing treatment, and to help raise funds for the SickKids Foundation. In this, it is wildly successful, with an ad that has been viewed almost half a million times (as of this writing), and one that has sparked lots of discussion. However, while the ad is motivational and empowering, it is not without fault.

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City of Philadelphia successfully passes a soda tax

Last week, Philadelphia became the first major city to pass a “soda tax.” While other cities have tried and ultimately failed to pass similar pieces of legislation, Philadelphia was successful. So what made Philadelphia different?

Picture from Flickr user Scribe215
Picture from Flickr user Scribe215

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Is plain cigarette packaging just smoke and mirrors?

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.

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Perhaps there is a drug that can prolong your life. It’s called money

A wise man once said that “mo’ money, mo’ problems” (Wallace, 1997). However, despite increases in supposed problems, one of the major benefits is increased life expectancy.

New research published in JAMA last week examined how big a difference earning more money makes in life expectancy, as well as how this changes by geographic location across the United States. Researchers collected tax records from 1.4 billion individuals from 1999 to 2014 aged 40 to 76. Of these, around 4 million men died, compared to 2.7 million women (mortality rates of 596.3 and 375.1 per 100 000 respectively). They examined these data to look at what predicted life expectancy at age 40, after adjusting for race and ethnicity.

What makes New York different to other US cities? | Photo credit Kah-Wai Lin
What makes New York different to other US cities? | Photo credit Kah-Wai Lin (click for more)

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