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.
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.
In public health, we rely heavily on samples, as measuring everyone you are interested is often impractical. However, this requires a lot of thought and development in order to avoid unintentionally biasing your sample, as was the case for the USC Dornslife/LA Times Daybreak poll.
Last week, a story came out about how one 19-year old black man in Illinois was single-handedly changing the standings of the US Presidential election. This was based on the results from the USC Dornsife/Los Angeles Times Daybreak, a survey of voter attitudes on “a wide range of political, policy, social and cultural issues.” In this survey, Donald Trump has generally held the lead, until last week, when Hillary Clinton came out in front. Interestingly, this is markedly different than most other national polls, that have shown Clinton is generally ahead, or a much closer contest than that poll would have you believe. So what happened?
Last week, I ran across this very entertaining piece over in Healthcare Dive about the new ICD-10 codes. The International Classification of Diseases (ICD) is an incredibly useful tool in public health that basically can reduce an injury to a series of numbers. As you can imagine, this is very powerful when it comes to determining if something is on the rise. Researchers can easily count the number of times something occurs, and if it’s up from previous years, there might be something there.
Part of the beauty of the ICD-10 codes is how specific they are. The previous system, ICD-9 (creative, I know) wasn’t nearly as specific as they only had 13,000 codes compared to the 68,000 in ICD10. With the advent of ICD-10, The Powers That Be have gone into painstaking detail breaking down injuries, diseases and other maladies into incredible precise codes that can be used by researchers and public health professionals.
Today, we’re going to go through my favourite ones.
Do you know what code it is if you get hit by a Macaw? Because one exists. | Photo via National Geographic
W55.89XA: Other contact with other mammals
There are many codes for contact with mammals. Raccoons, cows, pigs and cats are all represented. However, the mighty seal is not covered, which made Buster Bluth very sad. He would have suffered from W55.89XA.
I’ll be chairing a session titled “Youth Injury Prevention in Canada – Where should we direct our intervention resources.” It promises to be an interesting presentation, where we’ll be discussing injury in Canada, and where to start tackling the problem of injury. This session is scheduled for Wednesday, May 28th from 1:30pm – 3:00pm.
Injury represents one of the most important negative health outcomes experienced by young people in Canada today. Injuries inflict a large burden on children and adolescents and their
families and communities. Injury events are costly in so many ways, whether measured in premature mortality, or the pain, disability, lost productivity and emotional consequence of non-fatal events.
This panel will be made up of child injury researchers and advocates who will make their case for different forms of injury prevention intervention. At the end of this panel, delegates will: understand more about the burden of youth injury in Canada; be aware of at least four different avenues for injury prevention intervention (primordial intervention, context-level interventions, safe sport and peer-influence interventions); have identified the rationale, strengths and limitations of each intervention approach; and have learned more about ways to undertake and gain support for youth injury prevention (from the CPHA conference program).
Click to go to the conference website
My second presentation is one of the studies from my PhD, titled “The influence of location of birth and ethnicity on BMI among Canadian youth.” This is a study that’s in press (woo!), and represents my own research focus. This one will be in the Kenora Room, on Thursday May 29th 2014, from 11:00am to 12:30pm.
Background:
Body mass indices (BMI) of youth change when they immigrate to a new country. This occurs by the adoption of new behaviors and skills, a process called acculturation.
Objectives:
We investigated whether differences existed in BMI by location of birth (Canadian vs foreign born) across 7 ethnic groups, both individually and together. We also examined whether time since immigration and health behaviors explained any observed BMI differences.
Methods: Data sources were the Canadian Health Behaviour in School-Aged Children Study and the Canada Census of Population. Participants were youth in grades 6-10 (weighted n = 19,272). Sociodemographic characteristics, height, weight, and health behaviors were assessed by questionnaire. WHO growth references were used to determine BMI percentiles.
Results: Foreign-born youth had lower BMI than peers born in Canada, a relationship that did not decrease with increased time since immigration. Similarly, East and South East Asian youth had lower BMI than Canadian host culture peers. Finally, Arab/West Asian and East Indian/South Asian youth born abroad had lower BMI than peers of the same ethnicity born in Canada. These differences remained after controlling for eating and physical activity behaviors.
Conclusions: Location of birth and ethnicity were associated with BMI among Canadian youth both independently and together.
Implications: Our findings stress the importance of considering both ethnicity and location of birth when designing and implementing interventions. While currently either one or the other is addressed, our study shows there is heterogeneity in BMI by specific ethnic groups depending on whether they were born in Canada or not.
As always I’ll be trying to livetweet the conference. I’ll be using the #CPHA2014 hashtag, so feel free to follow along online! As always, there are a wide range of presentations and workshops, so I’m excited to attend.
If you’re attending the conference, leave a comment with details of your own presentation so that other readers can attend your talks. And if you see me at the conference, be sure to say hi!
A quick update for all our readers – Cristina and I (Atif) will be in beautiful Gainesville, Florida this week for the National Association of Science Writers/Council for the Advancement of Science Writers annual conference!
Scientists know science. And they’re good at getting science news. Know who’s not? Non-scientists. Yet non-scientists outnumber scientists, and their attitudes, believes, intellects (or not) and their votes help determine science policies, from funding for stem cells to what’s taught in school. The near-extinction of science reporters at local news outlets has created a gap in a steady stream of legitimate, dependable science news. Yet today there are more ways than ever to reach the general public. This session is about expanding your audience beyond the science in crowd. We’ll talk with two young scientists who are passionate about finding new ways to reach new audiences and we’ll explore ideas for how PIOs, freelancers, staff reporters and even scientists themselves can take a lesson from the universe and expand.
If you see either of us around, be sure to say hi! We’ll be at most of the events, and would love to meet you!
You’ve spent the last month working on a manuscript/paper, have fleshed out your ideas, spent countless late nights editing and making things sound *just* right, and you’ve finally sent it in to your supervisor. This will be the draft. This will be the one that they read and go “Wow! Good job! Submit this to Nature immediately!” And it’ll be accepted within a week, and you’ll be flown to Washington to present the paper to President Barack Obama himself, and, while you’re there, BB King will show up and you’ll jam together in the oval office, and, just when you think you’re about to finish your Epic Blues Jam Session, Bill Clinton will come by and play the saxophone.
But then, your supervisor sends you your paper back, and it’s either covered in red ink or there are 714 comments in Microsoft’s Track Changes.
This is *literally* the most appropriate GIF I could find.
One of the major reasons you’re in grad school is to learn from these experiences. There is a reason your supervisor is the Canada Research Chair of Awesomeness, or is internationally known for their work. It’s because they’re very good at what they do, and part of what they do is write, and write well. Your goal is to learn everything you can from them, and in that process, improve your skills. And writing is just one part of this process – your ideas will need refinement, your writing will need work, your teaching will need improvement, all of these are skills you can work on during your graduate education. However, in order to improve, you need to deal with feedback, which can come from a wide range of sources including your supervisor, your students (via TA/TF evaluations) and people at conferences.
1: Take a break.
The first thing I tell all the students I work with when they get back corrections is to read it, then leave it. Skim over the comments, get that initial “THIS IS THE WORST NEWS EVAR!” feeling out, and then go for a walk. Once that initial visceral response has passed, you can start dealing with the comments themselves. As this 99u article says:
Don’t react defensively – or aggressively – no matter how hurt, disappointed, or annoyed you feel. Start by taking a deep breath and reminding yourself of your goal.
2: Remove emotion from the equation.
As silly as it sounds, you do get emotionally attached to your writing over time. You’ve spent countless hours tweaking everything, making it sound *just right* before sending it in. You’ve read and reread sentences again and again to make sure they’re clear. Your supervisor then rewrites many of those sentences, and may suggest that some are unclear and need work. At a conference, someone might be less diplomatic, and call your work all kinds of names. You need to take emotion out of the equation as you hear those comments, and decide what comments have merit and require further thought. One thing you should not do is take criticism of you to be a personal attack. Negative feedback isn’t personal. By removing any emotional responses from the comments, you can evaluate comments on their own merit, and decide how to deal with them.
This may be extreme, but you get the idea.
3: Triage comments
In an emergency room, patients are triaged. Those with life-threatening conditions are identified as high priorities, while those who do not need immediate attention will be waiting for beds to open up. Similarly, you need to identify which comments are important, and need to be addressed immediately, and which are stylistic and you can let slide. Pick your battles.
4: Identify constructive criticism
We’re now thinking of comments outside of those that your supervisor would give you – we’re into the realm of feedback from students, audience members at presentations, and others. Listen to the comments, and understand why the feedback is being given and what you can do to improve. What you really need to do here is identify what is constructive and helpful, and where the comment is coming from so you know how to fix it. Use the comments to help you, and be objective about whether or not it is useful – even if you don’t like the comment.
5: Ignore personal attacks
One of the best pieces of advice I got as a Masters student was to listen to all comments and evaluate them all, even the ones you don’t agree with, but to always ignore personal attacks. And you will get personal attacks – students will write mean comments in TA evaluations, people will attack you at conferences, and, especially if you put your ideas out on the internet, you will get called all kinds of names. It’s very easy to dwell on those comments: don’t. You know you’re good at what you do, and don’t let anyone tell you otherwise.
This GIF always makes me laugh. I don’t know why.
6: Don’t listen to everyone
And thus we get to the final point: don’t listen to everyone. Everyone will have advice, everyone will have an opinion. Take the points that you like, synthesize them, and use your own judgement to decide what works for you and fits your project/worldview (that includes this article). Don’t accept everything blindly. Decide what you stand for, and if someone is arguing with you about it, plant your feet firmly and don’t budge.
Think about the most recent message you heard on TV. If you’re like me and watch a lot of sports it probably had something to do with going “All in for Week 1.” Alternatively, maybe you’re thinking about Importing from Detroit. Or maybe you want to see a day in the life of LeBron’s Samsung Note II. But how often do we see effective marketing of public health messages?
When it comes to public health, how much time do we spend promoting our message? Perhaps the only “public health” messages people see relate to two things: 1) phamarceuticals (although this varies by region) and 2) seasonal vaccination programs. The way advertisers think about messaging is markedly different to the way public health professionals think and thus how we convey information. Rather than talk about how to “communicate a health risk” maybe we should think about how to “market a message.” It’s a simple, but seismic shift.
We exist in a strange society these days. Jenny McCarthy is viewed as an authority on vaccines and people listen to the opinions of Ben Affleck and Sean Penn when it comes to politics. Yet people who study and have dedicated their lives to these causes remain out of the limelight and hidden from the public. While everyone knows about celebrities who campaign on issues, how many people can name a researcher who study them? One problem facing scientists is the lack of communication between science and the public: we’re perceived as living in the ivory tower of academia and are totally out of touch, or worse, we’re in the pocket of Big Pharma/Food/The Umbrella Corporation/Evil Faceless Corporate Interest.
But in reality, scientists are just regular people with an interest in one specific part of our world, and we want nothing more than for everyone else to find out work as fascinating as we do. It’s something that Jorge Cham of PhD Comics discusses in his TEDxUCLA talk, where he highlights how he was hired to create a video (that you may have seen) about the Higgs Boson.
There’s a definite gap between scientists and the public, and three questions immediately come to mind: 1) Why do scientists not engage, 2) How can scientists engage and 3) How do we find a celebrity to endorse “science”?
Mr Epidemiology 