Joy for the nation...we could use that.

"Senna", the documentary film about late Brazilian Formula One driver Ayrton Senna, is in part about how one person provided some degree of happiness and relief for a nation. Upon his death on the track at the San Marino Grand Prix in May 1994, a Brazilian woman said, 

"Brazilian people need food, education, health, and a little bit of joy. Now that joy is gone." 

Her sentiments were mirrored by the national mourning that surrounded her, in a country wrought by poverty and inequity.

Sounds familiar? It should. We are part of an increasingly polarized society, fighting with poverty and a host of social ills. Where's our "Ayrton Senna"? Do we need one collectively, or are we divided such that we need many? Can we find that power in ourselves, and if so, can we share it?  I don't know, it just made me think. 

 PV

Give it all your "bleepty bleep"....regularly.

" Her proud like her mother and ooohh momma’s sweet 

   So you just know that Juicy fruit ain’t gon’ fall too far from tree 

   So if we ever woop the woop

   I want all that bleepty bleep 

   On this nasty carpet Bixby fresh on one knee 

   Say I do I do I do I do I do 

   So we can float up outta here in this hot air balloon 

   Lets put a baby butterfly up in your lil’ cocoon

   And maybe 2030 our baby, she’ll be nerdy make the whole club swoon." 

  Excerpt from Andre 3000's verse on Jeezy's, "I do" 

This is some inspired, positive (and personally relatable) work from Andre 3000, who regularly produces very insightful lyrics. Coupled with a ridiculously funky soul music sample, the verse closes out a track that I should not have been surprised by given the players involved.  Young Jeezy's not been on my playlist much, but that's about to change. 

What does this have to do with health? Well, for me, wellness is as much about how I feel as it is  about "my numbers" (weight, blood pressure, cholesterol, etc), and music makes me feel good. Dancing can be great cardio, and the overall feeling I get from dancing to good music is irreplaceable. To feed that passion, I make space to listen to my music, hear the lyrics, feel the beat, and get lost in that emotion. Dancing, happens all the time! You might catch me on the metro bending knees everso slightly to a beat that's in my head or my headphones. The only places I don't dance are in meetings and while giving addresses/ lectures, but I'm sure I'll be moved to dance while at the lectern one of these days. 

 I say all this to say that my passion for music moves me, and I believe helps keep me healthy. Finding the things that work for you is a personal journey. You can incorporate any healthy activity you like into your routine. Just make sure you make it routine (3-5 times / week).  Maintain it because you love it, so when you "woop the woop" you give it all your "bleepty bleep". Trust me, you won't regret it.

PV

Tu me comprends? Public Health lessons in French......

Standing in line at Whole Foods I was privy to a conversation that I did not completely understand.  The  language flowed beautifully, the tones were warm, there was care in the words, care undiminished by pace.  I found myself connecting a few words, but not the whole conversation, it had been a while since I had heard conversational French. It reminded me that I needed to re-immerse myself in the language. It also reminded me that we can talk in people's presence and have them not understand much of what we say, even when we speak their language .  

I wasn't being spoken to, and I suspect that the people having this conversation had no idea of my eaves-dropping or my comprehension.  The latter had the potential to be cloaked by their ignorance of my knowledge of their tongue.  Come to think of it, they may expect me to understand them because it is not unusual for people from other countries to speak more than one language.  But speaking is one thing, speaking so you are understood is something else.  

Some of my public health colleagues embrace this mode of operation.  They work hard to ensure that health communications are clear and understandable by the target audience. Today's French lesson  reminded me that many of us may speak the language of the people we are serving, and may speak directly to them,  but still manage to speak in a manner that leaves them only understanding a few of the words.  Key concepts are missed, and major lessons lost on a group we want to "get it".  We may talk around them more than we talk to them, and I don't think we mean to. 

More on translation in the coming weeks.  

A bientot (see you soon). Bonne nuit ( good night). 

PV

PS - Tu me comprends? = Do you understand me? 

Step up to the mic.

My head and and my heart always grow heavy at the news of artists I like being sick or dying young. Why does it matter that they are artists? It matters because as precious as the lives of all our loved-ones are, for a multitude of reasons we may not be as influential in their "health-lives" as the artists that I am referring to.  When entertainers perform, people listen, and while we may not emulate everything that is being said, we nod along because we can relate to the words, the feelings, the circumstances.  We can see ourselves in the lives of others, we all do it from time to time.  So when people start dying suddenly, people we "just saw a week ago at the awards show looking good", then we should have no choice but to wonder how it happened, why it happened, and what about their situation is similar to ours? Do we see the connections, or do they not apply because their passing did not come with a beat and a remix? 

Part of the reason that I named this blog "Health, Remixed" was because I know that some people need to hear the remixed version of all the health information that is out there.  Same songs, different beats.   I know that regardless of what I say, it may sound like I'm preaching. I hope not, because I'm not trying to. Maybe it's my accent, and if I sound like I am preaching, please let me know... it's all love.  The death of someone who's music we love, that's a message that strikes a cord for a lot of people.  The violent deaths of Tupac, Biggie and others made us revisit conflict resolution in our communities.  Easy-E's HIV/AIDS infection had us talking about safe sex. Luther always had us talking about weight, but when he died after slipping into a coma related to his diabetes, we talked about that disease a bit more than we had...for a little while.  The same applied to Gerald Levert and Big Pun, and here we are now talking about Heavy D and Erick Sermon, men in their early 40's suffering from the complications of being overweight and obese.  Here's wishing the "E" in EPMD a swift and full recovery, and again, as I said on Twitter, thanks to him for sharing his story. We needed to hear it.  

Sermon's story is the only one from this cohort being told by the man while he lives. The others never got to say too much about theirs, and I can imagine why.  Health is so private that we often feel that sharing information about it may have people think differently of us.  There comes a point where on-lookers don't have to say a word though, and the trained eye can see the problem from across the room.  Truth be told, the on-looker doesn't really matter, because your health starts with you.  You, as the on-looker in the mirror and the listener to your own heart and lungs, you know when it started getting harder to do what you used to do, and you need to know why.  It might be your weight, it might be your joints, it might be your lungs, it could be something else, but whatever it is, you need to know. 

I asked people to tell me what they would say to the Heavy Ds, the Luthers, the Big Puns, etc. as they gathered around the table next week for Thanksgiving.  I asked because I want us to consider those moments not as times to preach or teach, but just to talk. To say, "I love you, and I want you here at Christmas, I want you here for New Years, I need you around at Easter, at my graduation in May, for my birthday, for my wedding, for the birth of my children, for my return from service (or wherever I have been)."  Or, "I just need you here to talk to you, to laugh with you, to hear your voice, to watch you sleep, to recite this rhyme while we dance."  

If something about what we are doing now has to change in order to increase the chances of all that happening, I think that the change is worth it.  We may not be putting all this down in a studio over  sixteen bars, but the tracks we produce in the studio that we call "home", they can be hits too.  All we need to do is be brave enough to humbly step up to the mic while it's still on.  Go ahead...step up. 

Peace, 

PV

The Diversity Download - App or Operating System file?

For the last few weeks I have been disheartened by some of the interactions I have had in my new sphere, the academic public health space.  While the experience has been more than 90% positive, it has sometimes left me concerned on a couple different fronts, so last night came right on time. I needed my faith restored, my system rebooted.  

APHA provides a great opportunity to reconnect with colleagues, friends, and to check the pulse on the future of public health practice.  I am still on the lookout for the talented, innovative professionals who will take us to the next level as we work to promote health. Running into former employees, fellow faculty, mentors, etc. is always something I look forward to.  What I got yesterday was a blend of  affirmation and inspiration, and the affirmation was not all good. 

Our colleagues in law and business seem to do a better job at embracing diversity. In public health, we would do well to work on this, because if last night was an indication of progress, we have a long way to go.  I know some people and institutions are doing it better than others, but our diversity "game" is weak, and there is a wealth of technical, cultural, linguistic, and interpersonal talent for us to tap into. That is, if we choose to. 

Just like a smart-phone app, embracing diversity is a concept that we have to download in order to use .  Trouble is, I do not see it on everyone's device.  Downloading diversity as an app isn't enough though.  It has to become part of the operating system, a file without which the enterprise does not work, or keeps crashing. Diversity as I define it here is beyond race, gender, and ethnicity. It is about inter-disciplinary collectives which are born from a clear understanding that we cannot do this "health thing" alone.  We have to be open to creating the proper partnerships at every level. Public:private, interagency, inter-discipline, trans-race / gender / ethnicity / community, you name it.  

The inspiration part of the equation is in the realization that there is room for improvement.  It all starts with dialogue, and with my system rebooted by a combination of colleagues, friends, (and others who don't even know that they influence me), I'm ready to fire-up the latest version of this "diversity in public health" app.  Stay tuned for more on this at www.PHVenturesGroup.com, coming soon.

Be well. 

PV

I had a flashback and I ended up here...

Ruminations about the Affordable Care Act reminded me of a situation I dealt with during an annual legislative session.  As the health commissioner for the jurisdiction, I had been asked to comment on a number of bills that related to health.  It was interesting to work with this material because in some cases there was good public health policy precedent for the proposed change to the law, while in other cases the bill was a neonate, born often from a place unknown to many of us who read them.   It was in the deciphering of these bills that we found strength in our collective skills and talents. {Aside - this reminds me that in a later post I must discuss the need for diversity in those teams.} Together, we would plod through the language of the bill to find the heart of the matter, and then decide if the recommendation had merit (usually based on our daily operations and our experience).      

Most of the time we are able to clearly state our position on a given proposal.  Sometimes we recommend amendments as a way to strengthen the bills.  Sometimes I would pick up the phone to call our intermediary and tell her how crazy (or brilliant) a particular bill was so she could work her magic and get things moving.  There were however rare occasions when we find ourselves in a bit of a spot.  

The example of this that comes to mind is a bill that sought to increase access to care for youth in our state.  A fine idea.  The problem was that at the local level we were already woefully behind on taking care of the existing eligible individuals in this already large and needy group.  It was not for lack of desire or effort, but rather a simple math problem.  Too many cases for too few case-workers.  Sure, we could work harder, but we were hitting the rev-limiter everyday.  Maybe we could work smarter, an eternal question with a number of confounders, but suffice it to say, some research needed to be done to see if this was the case.  

One option at our immediate disposal was to simply oppose the bill on the grounds that we did not see a way out of our existing case load, and that adding cases would stress the system too much.  In doing so, we ran the risk of being labeled as oppositional to the popular public health concept of universal health care access.  Alternately, we could support the bill, risk having any qualifying amendments be forgotten under the umbrella statement that  “county X is in support of bill xyz”. We went for option #2, to support the proposal, even given our tenuous position.  In my opinion, to stand against the  principle of universal access was to suggest that we did not embrace the concept.  

This scenario is playing itself out on a larger scale now as we deal with the pending implementation  of the  "Obama-care" package, and the prospect of adding patients to a system that is ill prepared to receive them. Back then, our support for these sorts of measures left us wanting for resources to handle the increased volume of patients. Sounds familiar?  We knew we would likely be over burdened, and paid little attention, but how’s that so different from the normal state of affairs for public health?  

Passing and implementing the new health care act is well beyond noble, and while it may lack in sufficiency, it is necessary. We have to start somewhere, and the plan on the table beats maintaining the status quo, and is well ahead of the alternative. Speaking of which, ask anyone in opposition to the Affordable Care Act for their plan.  You will probably get a blank stare and a blank piece of paper, because they don't have one.  With that understanding, how bad does it sound to stand on the principal of universal access and what "Obama-care" does to facilitate this goal? I'd say not bad at all, so let's get this done. We've got people waiting to be seen.

PV

"Mad Men" & Sugar, Sex, Stress.

Mad Men, the TV series about the NYC advertising world of the 1960s, has been touted as one of TV's most successful series of the last few years. The show's attention to details is laudable, from the development of characters, to the clothing and styling, to it's handling of some of the issues of the day.

The world depicted in the show is that of the privileged and homogenous majority population of the period. One issue of note is that while that group is white, the split that existed between Christians and Jews at the time is brought up in numerous interactions.   Another issue of note, sexism, is a constant thread for the show.  All Mad Men's women are victims of it, and I found the development of Peggy, the new secretary who quickly gains a promotion as she rises in stature in the company due to her intelligence and ability.  Becoming pregnant by a member of the executive team the night before his wedding had her gain some weight. We watch her eating pastries and piling on the pounds, and then discover that she is with child the day that she delivers.  They lost me a bit there, but I guess it is possible to be slim, have unprotected sex, get pregnant, gain a rack of weight, and not know that you are pregnant, it happens. She seems to handles her weight gain well, presumably because she finds her intellectual space to be of more value to her than her physical space. She basically gets lost in her work - does that sound like anyone you know? I think she abandons the baby though, which is a less palatable, and an issue for season two and beyond. 

So why am I posting about this? I am on alert for popular culture opportunities to discuss three public health issues - Sugar, Sex, and Stress, and Mad Men as it happens is perfect.  Besides being impressed by the range of social issues that the show deals with, I find it notable that this show about the advertising industry is in itself and advertisement for "1960's NYC for some", and a broader ad for " the public's health in America" at that time.  Smoking - everyone does it in the show; sex - everyone's having it and I neither saw nor heard mention of a condom or sexually transmitted disease; stress - manifested by mental health issues, more sex, and a heart-attack; and alcohol use, all get some face-time on the show. 

For all the sex in season one, beyond the aforementioned pregnancy and some marital discord, no one gets a sexually transmitted disease (STD).  Women are shown going to the doctor and get birth control, but no one seems to develop an itch, rash, or anything else STD-like.  I realize that that is not very savory, and I am sure that Don Draper with the clap would be a real downer for some of the show's fans, but that was sex in the 60's which was a prosperous period for purulent discharges related to STDs.   It might get the attention of some of Mad Men's fans, make it's way into the places where the show is discussed, and bring the topic to a space in which we are more comfortable.  An indirect public health dialogue-starter kit of sorts.  Nothing to be mad about at all.    

Foodie Chronicles III (never mind the order...) - Leaner or Lighter?

I recently linked to a good men's health article by Dr. Oz on my LinkedIn page. He set some goals / expectations for men of various ages which I found quite interesting. The article, , my own health journey, and the importance of the issue prompted me to pen this post. It's the third in the Foodie Chronicles series, but I am publishing it on this site as the first installment because I think it is timely.

Body composition, the issue of being lean versus being light, has been well discussed and studied. There are a few body composition options - we can be heavy and fat, or heavy and lean (lower risk of heart problems, stroke, diabetes, etc.). We can also be "normal" weight and lean, or "normal" weight and less toned, some call that "soft". Some of my friends call the "normal" weight folks "skinny", I prefer the term "efficient" (especially the normo-lean crew). The bottom-line is that we grow accustomed to people being a particular size, and changes to that are not always well received (for a barrage of reasons). Changes in body composition are less frowned-upon, but "don't get too small" is the plea I hear from time to time....What it looks like on you, and what it is in reality, are important matters for a different post. Ultimately, when genes, disease, desire, and access to resources aside (you know I do not belittle any of those factors), what we do defines which body-type we have.


Beyond weight, there is other data that is crucial for you to know, for example, blood pressure, cholesterol levels, and markers of blood sugars like hemoglobin A1C. Trouble is, we do not see those markers regularly. The data we do see is our weight on a scale, and sometimes that is over-done. Do not weigh yourself daily! From the time you go to sleep to the time you wake up, with no exertion or intake overnight, your weight can shift by a few pounds - most of this is due to water, 1 liter of which weighs 2.2 pounds (please excuse the unit shift). Between that, and your diet / exercise routine, your weight can fluctuate a lot without any significant change in fat or muscle content. For the most accurate number, weigh yourself once each week, first thing in the morning nude, and after you have urinated.

It has been about 10 years since I started taking better care of myself, so some people do not remember "portly Pierre", and to be honest, everyone (except my Mum...) was really polite about my size, perhaps for fear that I might sit on them. Fast forward to today where at 5'9" and 189-192 lbs, people tell me I "look like I weigh a lot less". They do this "eyeball scale" estimation based on what they know of weight from their own scale, and from the media. Data from the latter source is mainly from athletes, although I think that the same stats for actors and musicians might be helpful to some people as a point of reference. The danger in this is that it is inherently inaccurate, and our weight sense is often misleading as it relates to what looks good versus actually what is.

I got leaner by changing the contents and portions on my plate, what was in my refrigerator, and my workouts. Less sugar, more water, and "cleaner" smoothies, combined with fewer "steady pace" runs, more speed-work and body-weight routines (burpies, traveling push-ups, split-jumps, planks, etc). I still love to eat and sit still, so sometimes I need encouragement, we all do. Mine comes from various sources, like the Oz article or 41 year-old rapper Joseph Cartagena (aka "Fat Joe"). I think his story needs to be told more widely (no pun intended). That reminds me to send a very respectul head-nod to Christoper Rios (rapper Big Pun) who died at age 29 from complications of chronic weight-related disease. He would have turned 40 this year.

All this is to say - find your inspiration, select your target, map it out, allow for minor deviations, and stay the course.

Be well,

PV

Build a salad campaign. Lunch, and more education...

DC public schools are back in session, and their food guru is asking for volunteers to help with an "eat more salad" campaign.  This sounds right up the alley of Nat and Nick, the founders of SweetGreen, a salad and frozen yogurt (SweetFlow) spot now in ten locations in the DC area.  These guys have a curriculum that I am looking forward to see that is designed to help DCPS students learn about all the fun that can be had with salads.  Just like salads in schools, it is a step in the right direction.  You know what I am going to ask next though, how can we make salad ingredients cheap enough that those salad-building lessons learned by day are not substituted for less healthy offerings by night?

Tasty is good, tasty + education is better, tasty + education + access is priceless.  Let's see what we can do to make the price less. In the meantime, if you want to lend a hand, check MD's WaPo blog link for the details by clicking on the title of this entry.

PV

Exercise improves memory, attention, and decision-making.

You probably knew what was in this Science Daily article, and you may have already increased your heart rate for at least 30 minutes this morning.  If not, you still have time to do your mind and your body some good today, even if today is the first day that you do it.  The benefits of regular exercise are well documented, and beyond the temporary discomfort that you may feel while doing it, there is a feeling of great accomplishment when you are done.

For some, the rewards come during exercise, like running that third mile split a little quicker without really feeling it. For many, the reward of exercise comes right after, when the endorphins are flowing and you feel a bit euphoric.  For most, the benefits take a while to be realized, as mental and physical endurance improves along with body efficiency (weight, heart rate, and blood pressure reduction).

There is a benefit to all three phases of the reward scheme, and they are all worth a little effort.

Are you jinglin', or jigglin'?

What did LL Cool J mean exactly? Was it Christmas and she had bells on?  Was she carrying extra change in her purse, and was running to feed the parking meter? Maybe it was her jewelry, "bamboo earrings at least two pair"? Or maybe it was something else LL was taking poetic liberties with.  While technically jingling is a sound, MCs have long been imaginative with their verbiage, so why not have jingling be a word used to describe how something moves, and why am I writing about this?

This morning, while doing a bit of cardio, we may have noticed some, well,  jingling. In actuality it's jiggling, but there was no sound. It wasn't terrible, and hopefully nothing on us is big enough to smack us in the face and knock us out, it was (and has been) present nonetheless.  While some might say it's nothing to worry about, it is that abdominal girth that puts us at risk for heart disease, diabetes, and all the associated problems. That's what I am working on reducing my risk of.  In general, women have body parts that because of their size and composition, may be prone to "jingling" - real talk. What's not really supposed to jingle on any of us is our mid-section, our core.

A strong core helps with posture, reduces back pain, and makes you better able to maintain good form during your workouts.  Overall, working on your core strength should be a major part of your exercise plan.  The beautiful thing about core workouts is that they can be done anytime and do not all require getting on the floor or putting on special clothing (...if that took you somewhere lewd, stop it!) There are tons of core exercise examples online from the very simple to far more complex. So do a little googlin' to find out what you can do to work on the jinglin', go 'head...

Grocer + Bodega + Talent = ?

The tweet was food related (as so many of them are). A very engaging actress commented on how expensive (and tasty) food was at a particular grocery chain, and went on to say that she was "just trying to eat right". For some of us, taste and goodness beats affordability everyday. With the means to pay, we can choose what we want from the menu.

I asked her (very publicly mind you), if she'd consider engaging in work related to food deserts and obesity with said grocer. Not working for the grocer, and not being even an acquaintance of hers, I recognize that my query was at once presumptuous, and very forward, but I think it was worth the shot. Talented, engaging spokes-people can help drive traffic and therefore drive behavior change - companies use this rationale regularly. In this case, if a partnership was to develop b/w said grocer, and a corner-store in a financially strapped neighborhood, and be promoted by an advocate (like the actress), then we might see a couple things happen. For starters, as a "pseudo-satellite" to the high-end "good" grocery store, the bodega would have to adjust it's selections so there were less processed foods on the shelves. Next, prices would be placed in line with (previously sold) similar products. Last, there could be some sort of shelf labeling implemented so that diabetics, for example, would know that this aisle has food that is in line with what your healthcare provider suggested you eat as you work on bringing your blood sugar down.

Sure, I'm pitching something here, because I believe it can work. If you have the connects to make this happen very soon, keep me posted on how it goes so we can learn from your experience.  The only way to do it is to try it. Walmart, Target, Whole Foods...my number is 443-....

PV