The impact of food price spikes

As we discussed in a previous post, several causes led to a massive spike in food prices internationally in 2008 and again a few years later. The average world price of rice, for example, rose by 217% between 2006 and 2008. Classical theories have suggested that we shouldn’t worry about these spikes: that the high prices will lead to more production (attracting farmers to produce more, which will drive prices back down), people’s wages will adjust to costs of living, and people will be able to substitute for expensive items with other foods. But a new report tracking how the most-affected people have responded to the food spikes reveals that classical theories may be a bit out of touch…

New IOM report on US versus…everyone else

The Institute of Medicine has released a major new report today on the reasons why the United States seems to have poorer health, despite its greater wealth, as compared to other industrialized countries.

Gutting the research and development treaty

For several years, health advocates have tried to assemble a treaty to fund research and development on neglected diseases that predominate in poor countries. This week, US and EU negotiators gutted that goal.

Is microinsurance really revolutionary?

The New York Times this week profiled “microinsurance”– local health insurance schemes for the poor and sick–which the Times characterized as a revolutionary new safety net system for the world’s poor. The idea behind microinsurance is simple: big insurance companies sometimes don’t give coverage for the poor and sick, so just like microlending gave loans to poor people opening businesses, microinsurance is a way to pool money among the poor in order to cover the catastrophic expenditures associated with illness.

We asked our colleagues of epidemiologists and public health workers and humanitarian relief organization directors to find out what they thought about these schemes…and, surprisingly, we couldn’t find a single one who knew of a good example of a microinsurance program that actually worked. In fact, they were almost universally critical of the idea. What gives?

The Robin Hood Tax: from food speculation to regulating the banks

With the recent attention garnered by the “Occupy Wall Street” movement, even the slow world of epidemiology has started to pay attention to the idea that the behavior of banks may be a significant factor in human health. Banks have critically affected the availability and pricing of food, and precipitated the mortgage-backed security crisis and subsequent economic recession that has resulted in significant joblessness and associated loss of health insurance. One idea that’s caught on internationally is the idea of discouraging risky transactions made by the banks–the kind of transactions that precipitated the global economic recession–and also raise money for “the 99%” who have been harmed by the actions of bankers. In this week’s post, we analyze the workings of such a “Robin Hood Tax“, and analyze what implications such a tax might have for public health.

Should doctors make “house calls” again? Preventive hot spotting and early active intervention

In the olden days, doctors would travel from house to house when community members fell ill. Now, we usually expect patients to come to our office-based clinics. The modern model of care is certainly more efficient for us as physicians. But it’s also a barrier for patients to receive medicine; the highest-risk people usually make it to our clinics after being discharged from their first or second hospitalization, well after high blood pressure or diabetes has already taken its toll on their bodies. Our latest research suggests that we can statistically predict which people are most likely to end up having chronic diseases five or ten years from now. We can pinpoint these people right down to which house they live in. Such predictive models present a new opportunity to prevent disease before it becomes costly or deadly. In this week’s post, we look at a new idea for community-based disease prevention in medicine: the geographical mapping of chronic disease risks, and preemptive visits of healthcare workers to households where people are likely to become ill in the future.

The largest famine in decades hits Somalia, Sudan, Ethiopia and Kenya… why?

While US newpapers have been infatuated with hourly stock price fluctuations, the press has almost totally ignored the start of the biggest famine in decades—a humanitarian crisis larger in scale than the Japanese tsunami and Haiti’s earthquake. In this post, we take a look at the available data on the emerging famine in the Horn of Africa, and its drivers.

Three decades of HIV …and still learning

On June 5, 1981, five cases of Pneumocystis carinii pneumonia were reported among young men in Los Angeles, in what was to become the first account of AIDS. The pandemic that transformed Earth now marks its thirtieth anniversary this month. And while much attention is appropriately being paid to declarations made about the Millennium Development Goals and reports on the broad state of the disease in different continents (see the mortality graphs below), it’s easy to forget some of the critical lessons we’ve learned over the years from this unparalleled pandemic. In this week’s blog post, we’ll revisit some of the historical lessons we’ve learned HIV: from the redefinition of the behaviorist model of health promotion, to the detailed tax records of the pharmaceutical industry.

Food insecurity and the irrigation of food deserts

Michelle Obama has reincarnated the food pyramid as a “healthy plate“. The plate is divided equally between fruits, grains, vegetables and protein–a balanced dinner plan to lead the nation towards a leaner and less diabetic future. As part of applying this new plate method to the real world, a patient of mine came to clinic with a map of our city.

“This is what I’d need to do buy everything on a healthy plate,” he said.

How much would he have to spend for this trip to the grocery store? Given public transport and food costs, about $25–twice his post-rent, post-tax daily income. And the trip would require 49 minutes of transportation time, each way.

This patient, like many others, lives in an American “food desert”: a neighborhood that features more liquor shops and gas stations than it does produce stands or grocery stores. In today’s post, we explore the data behind food deserts, some of their politics, and think about how to intervene in the midst of dilemmas about food price spikes and recessions.

Advancing primary care in global health – avoiding past mistakes

The President’s Global Health Initiative (GHI) has outlined a new U.S. strategy for global health. Secretary Clinton recently described the GHI as aiming to bolster health system development and particularly primary care, tackle health problems that can be eliminated with relatively little investment (for “sustainability”), and focus on maternal and child health (MCH).

To an outsider, this all sounds pretty good; but to those who are familiar with the history of global health, the rhetoric around the GHI ominously harks back to past mistakes. In this blog entry, we discuss the history behind primary care in global health, to explain why previous attempts at “health systems development” perversely backfired in the 1970s, 80s, and 90s.