Monthly archives: September, 2017

Mesothelioma, A Lifecourse Perspective

By: Emily Walsh, in collaboration with the Mesothelioma Cancer Alliance, and Amanda Wojan

Exposure to environmental toxins and the subsequent disease exposure can lead to lifelong complications and issues. While people are more commonly aware of the threat of carbon monoxide or lead, asbestos is a toxin that is very much present in daily life and has the potential to be vastly more dangerous. Widespread use in the past century means that existing asbestos can be readily found in homes, schools, and spaces, both across the United States and globally. A known human carcinogen, asbestos has been proven to cause several illnesses including asbestos cancer, more widely known as mesothelioma, which develops in the linings of organs. The most common type of this rare cancer is pleural mesothelioma affecting the lungs, however it can also present in the abdomen and around the heart.7

The risk of exposure to environmental toxins is inequitably distributed and most impacts marginalized communities. Studies have noted that communities that are low-resourced, with higher populations of people of color are more vulnerable to these exposures.1-5 Unfortunately, these communities are also not positioned to adequately address the source of these toxins. Having fewer economic resources can lead people to live in substandard housing conditions, where toxins such as mold and asbestos are present.6 This is a clear example of how social factors can work to determine one’s health outcomes. Because of the unjust and unequal distribution of these exposures, rectifying and addressing this inequity should be a public health priority.

Heather Von St. James is an 11-year survivor, receiving her diagnosis of malignant pleural mesothelioma just over three months after giving birth to her daughter. She was exposed to asbestos as a child, wearing her father’s work coat while doing her outdoor chores everyday. Asbestos fibers were in the dust caked into the fabric from his construction job, and she unknowingly breathed them in as she wore the coat. This exposure eventually led to her diagnosis with this aggressive, rare cancer at the age of 36.

One of the dangers of this cancer, as well as other asbestos-related diseases, is that it can take anywhere from 10-50 years after exposure to develop. This long delay of symptoms, coupled with their general nature, can make it easy to receive misdiagnoses at first. As such, patients are often faced with a poor prognosis and limited treatment options. Heather faced a prognosis of just 15 months to live without treatment. However, an intensive, experimental surgery that removed her left lung, two ribs, half her diaphragm, and the lining of her lung and heart, followed with chemotherapy and radiation, meant that she outlived her best-case prognosis of ten years and is still celebrating her health today.

Heather’s story illustrates a powerful point about life-cycle illnesses in that they do not always have to be chronic, yet they can touch every stage of the life course. While her exposure occurred as a child, her cancer developed years later and her life was irrevocably changed by her diagnosis. Physically, Heather must live with one lung and faces limits on her activity. She had to give up her career, and she faces lifelong anxiety around her bi-annual scans. Her cancer journey will follow her throughout her entire life.
Heather has taken this experience and channeled it into her passion and calling as an advocate. She now works to support the mesothelioma community by connecting with patients, educating people about what mesothelioma is, and spreading awareness about rare cancers. Speaking from experience, she also lends her voice in Washington D.C., often working to advocate for legislation that supports a full and final ban on the use of asbestos in the United States.

Mesothelioma Awareness Day is September 26th and it serves as an ideal opportunity to call attention to the education, awareness and support this community and cause needs.
To learn more about pleural mesothelioma, check out this website: https://www.mesothelioma.com/mesothelioma/types/pleural.htm

References:
1 Sampson, R. J., & Winter, A. S. (2016). The racial ecology of lead poisoning: Toxic inequality in Chicago neighborhoods, 1995-2013. Du Bois Review: Social Science Research on Race, 13(2), 261-283.
2 Moody, H. A., Darden, J. T., & Pigozzi, B. W. (2016). The relationship of neighborhood socioeconomic differences and racial residential segregation to childhood blood lead levels in Metropolitan Detroit. Journal of Urban Health, 93(5), 820-839.
3 Berg, K., Kuhn, S., & Van Dyke, M. (2017). Spatial surveillance of childhood lead exposure in a targeted screening state: an application of generalized additive models in Denver, Colorado. Journal of Public Health Management and Practice, 23, S79-S92.
4 Winter, A. S., & Sampson, R. J. (2017). From Lead Exposure in Early Childhood to Adolescent Health: A Chicago Birth Cohort. American Journal of Public Health, 107(9), 1496-1501.
5 Hao, H., Chang, H. H., Holmes, H. A., Mulholland, J. A., Klein, M., Darrow, L. A., & Strickland, M. J. (2016). Air pollution and preterm birth in the US State of Georgia (2002–2006): associations with concentrations of 11 ambient air pollutants estimated by combining Community Multiscale Air Quality Model (CMAQ) simulations with stationary monitor measurements. Environmental health perspectives, 124(6), 875.
6 Evans, G. W., & Kantrowitz, E. (2002). Socioeconomic status and health: the potential role of environmental risk exposure. Annual review of public health, 23(1), 303-331.
7 https://www.mesothelioma.com/mesothelioma/types/pleural.htm


MCH Student Op-ed: Don’t call it universal without including abortion coverage

By: Vidya Visvabharathy, MPH (c)

As Sen. Bernie Sanders prepares to introduce a universal health care bill in the next few weeks, many progressives who support a universal single-payer program worry about its effects on abortion access. Can we win Medicare for all while protecting hard-won reproductive rights? As a woman of color, a reproductive rights advocate, and graduate student of public health, I recognize the importance for marginalized groups to stand in solidarity for progress to happen. I urge single-payer advocates to push to repeal the Hyde Amendment as part of our fight for truly universal health care.

It’s no surprise that the majority of Americans support a national health program. Although the U.S. spends twice as much on health care than other industrialized nations, key health outcomes such as life expectancy and infant mortality fare much worse as compared to our international counterparts. Most of this difference in spending can be traced to our fractured, profit-based insurance industry, which wastes nearly a quarter of our health care dollars on billing, advertising and profits, none of which contribute to quality of care. In contrast, a single-payer health program is a universal health care model that is publicly financed and covers all Americans for medically-necessary care, such as doctor visits, hospital stays, long-term care, and drugs.

Single-payer has been a long-standing progressive cause, and would seem to have no problem gaining support from all progressive groups. However, many women’s advocacy groups are hesitant to back a single-payer system because it could restrict access to abortion. The Hyde Amendment, passed in1976 after the landmark Roe v. Wade case legalized abortion, bans all federal funding for abortion services except in the cases of rape, incest, and life endangerment to the mother. Therefore, a single-payer program could not fund abortion, unless explicitly stating that reproductive and abortion services would also be covered. Single-payer advocates should ally with women’s advocates and work to repeal the Hyde Amendment to increase support for both causes.

Progressives can learn a lot from efforts to enact single-payer programs at the state level. For example, in November 2016, Colorado lawmakers tried to enact a health care system similar to single-payer, known as ColoradoCare. However, NARAL (National Abortion and Reproductive Rights Action League) opposed the plan because it would leave more than 550,000 women without access to  abortion services due to the state’s constitutional ban on funding for abortions except for life-threatening circumstances. Many women who have access to abortion services through private insurance plans would have lost this coverage under ColoradoCare. According to a statement by NARAL, the bill “is not truly universal” since it does not guarantee abortion services. Ignoring reproductive health caused ColoradoCare to lose key supporters necessary to win universal care.

The statewide single-payer legislation in New York serves as a promising model that explicitly incorporates reproductive services in the health system. The program, known as New York Health, covers all medically-necessary services that are currently covered by the state Medicaid program, including abortions. Diverse health organizations such as New York State Family Physicians and the Reproductive Health Access Project were heavily involved in crafting the bill from the start, underscoring the need for single-payer and women’s health groups to build legislation together.

In order to avoid the mistakes of ColoradoCare at both the state and national level, single-payer groups must explicitly advocate for coverage of abortion services, and work with reproductive health advocates to repeal the Hyde Amendment. While it is laudable that the single-payer advocacy organization Physicians for a National Health Program recently released a statement supporting abortion coverage, supporting causes ideologically is not enough. Reproductive health services, including abortion, must be explicitly written into any single-payer bill. If we want a universal health care system, it must be a system that covers comprehensive reproductive services as well.

Vidya is an MPH student completing her degree in MCH-Epidemiology. Her research interests include women’s health and reproductive justice. In the future, she hopes to practice as a physician-advocate for marginalized populations in Chicago. 

This article was originally posted on KevinMD at the following link:

http://www.kevinmd.com/blog/2017/09/dont-call-universal-without-including-abortion-coverage.html