IMPACT Issue 4: Health, Fall 2014 by IMPACT Magazine

ISSUE 4: HEALTH | DECEMBER 2014

IMPACT MAGAZINE Our mission is to cultivate a culture of student involvement in social change and to bring awareness to the social impact activities of students, alumni, faculty, and organizations in our immediate and global community. FOUNDERS AND EDITORS-IN-CHIEF Valentina Raman Frances Starn MANAGING EDITOR Mayookha Mitra-Majumdar

WRITERS Connor Boyle, Hannah Dardashti, Taylor Hosking, Christine Hu, Anissa Lee, Leora Mincer, Pallavi Wakharkar, Sanna Wani, Aaron Wolff, Yuqi Zhang

CHIEF COPY EDITOR Nicole Laczewski

COPY EDITORS Saraf Nawar Ahmed, Sami Bronner, Emily Chen, Daniel Chung, Jordyn Horowitz, Jessica Hundly, Aziz Kamoun, Iris Kim, Sola Park, Elizabeth Peng, Rebecca Pritzker, Dany Rifkin, Michael Stanton, Pallavi Wakharkar, Shamarlon Yates

PHOTOGRAHY EDITOR Connor Boyle

PHOTOGRAPHERS Konhee Chang, Aaron Guo, Sara-Paige Silvestro, Lucy Wang

DESIGN EDITOR Armaan Chandra

DESIGNERS Madeleine Andrews, Connie Fan, Taylor Nauden, Donato Onorato

ONLINE MANAGING EDITOR Ciara Stein

BLOGGERS Julianne Goodman, Guila Imholte, Grace Jemison, Melissa Lee, Kylie Maier, David Ongchoco, Jennifer Preys, Dylan Smith, Morgan Snyder, Nicolette Tan

FINANCE CHAIR Kathleen Zhou

FINANCE TEAM Jahanvi Sardana, Akshat Shekhar, Oona Yadav

MARKETING CHAIR Sandrine Nkuranga

MARKETING TEAM Mary Peyton Sanford, Kelsey Williams, Taylor Yates

COMMUNITY DEVELOPMENT CHAIR Yousra Kandri

COMMUNITY DEVELOPMENT TEAM Dana Kong, Samantha Mathews, Abhiti Prabahar, Gabriela Rodriguez

WEBMASTER Daniel Brooks

WEB & TECHNOLOGY TEAM Shaurya Dogra, Emma Hong, Karen Her

SPONSOR The Povich Fund for Journalism Programs at the Kelly Writers House

LETTER FROM THE TEAM The fast-paced world of college life can take a toll on many undergraduates. Juggling classes, meetings, rehearsals, interviews, and other academic and social obligations, we lose sight of our own well-being. When was the last time you worked out? Ate a balanced meal? Woke up feeling safe, rested, and anxietyfree? College students face unique emotional, mental, and physical health battles relating to diet, exercise, sleep, stress, sex, drugs, safety, and more. In the American College Health Association’s 2014 National College Health Assessment, college undergraduates reported that their academic performance was negatively affected most by the following health factors: stress (32.0%), anxiety (22.8%), and lack of sleep (22.4%). Depression affects us almost as much as the common cold and sore throats, at 14.1% and 16.3%, respectively. These numbers are an imperative to reframe our discussions of health and reassess our priorities. The great American reformer Horace Mann once called education “the great equalizer”. Perhaps the same can be said for health. While “health” brings to mind doctor’s visits and sterile operating rooms, being healthy is a lifelong process that transcends location. Across the United States and around the world, individuals experience economic, political, and technological barriers to living healthy. Educating ourselves about the state of health beyond university, state, and national boundaries is vital to fully understanding what it means to be healthy. With this in mind, we present IMPACT Magazine’s fourth print issue: Health. The following ten articles have been written, edited, and designed by the IMPACT team. We hope this issue inspires our fellow students to reflect on their health, act to improve the health of others, and work together to tear down health barriers in society, now and in the future.

â&#x20AC;&#x153;The body is like a piano, and happiness is like music. It is needful to have the instrument in good order.â&#x20AC;? - Henry Ward Beecher

THE

HEALTH ISSUE 06 10 12 14 16 20 24 26 29 32

Marijuana Decriminalization

The Past and Future of Criminal Justice and Community Health

| Taylor Hosking

Healthcare Harries and Hopes A Call for More Reform | Aaron Wolff For All Citizens

The Right to Adequate Healthcare

| Anissa Lee

Bridging a Wide Gap

Community Health Centers and Free Clinics in West Philadelphia

Student Voices on Sleep By the Numbers | Connor Boyle You Are What You Eat

The Changing Landscape of Diets and Nutrition

A Communication Crisis

Suicide Prevention at Penn and Beyond

Philanthro-fitness

Philanthropy with Benefits

Give a Sh*t

How Sanitation Saves Lives

Beyond Abortion

| Christine Hu

| Sanna Wani

| Pallavi Wakharkar | Hannah Dardashti

Broadening the Scope of Womenâ&#x20AC;&#x2122;s Health

| Leora Mincer

| Yuqi Zhang

MARIJUANA DECRIMINALIZATION: The Past and Future of Criminal Justice and Community Health Written by Taylor Hosking

hen University of Pennsylvania students returned to campus this year, Philadelphia was in the midst of a critical change in its drug policy: the decriminalization of marijuana. This decriminalization bill would make possession of up to an ounce (30 grams) of marijuana punishable by a $25 fine, with public consumption resulting in a $100 fine or nine hours of community service, rather than an arrest on record. Philadelphia is the largest city yet to decriminalize cannabis. Philadelphia Mayor Michael Nutter is also fighting to expunge records of people arrested for marijuana possession charges in Philadelphia in the past. In Philadelphia alone, over 4,000 people, mostly Black and Latino men, acquire criminal records for marijuana charges in a given year. Washington and Colorado have already legalized the production, distribution and consumption of cannabis. Legalization differs from decriminalization in that there will be no fines or community service for possession or consumption of marijuana and no arrests for involvement in production or trafficking.

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THE FEDERAL GOVERNMENT’S CATEGORIZATION OF MARIJUANA The federal government, however, still upholds legislation from the early 1970s, which deems any production or possession of marijuana illegal. Drug schedules are a ranking system that the government uses to classify how harmful a drug is to health, and by association, the level of federal regulation of the drug. There are five levels of scheduling. The first level is reserved for the most harmful and tightly regulated drugs and the fifth level for drugs that have beneficial medical uses, such as prescription drugs. For example, Schedule I drugs include heroine, ecstasy, LSD and peyote (cocaine is a Schedule II drug). The Comprehensive Drug Abuse Prevention and Control Act of 1970, enacted under the Nixon Administration, made marijuana a Schedule I drug. It is deemed to have no medical use and a high potential for physical dependency. Even people carrying medical marijuana could be arrested at any time in violation of federal law, even though the Obama administration has said it will not be pursuing people in compliance with their state’s laws. Penn Criminology professor Emily Owens points out, “Doctors are in a real conundrum because they get their right to prescribe drugs from the federal government, not the state, meaning they hope the federal government won’t rescind their license when they have to reapply every two years.” States have their own drug schedules and many states have ranked marijuana as a less harmful drug. What context could have led the Nixon Administration to categorize marijuana so harshly in the first place? The answer to this question can be largely found in the racialization of crime and drugs in the 1960s.

THE 1960s AND THE INITIATION OF THE WAR ON DRUGS In the 1960s, buying cocaine was as simple as purchasing it from the local drug store at relatively cheap prices. It had a significant degree of acceptance in popular culture. Center for Africana Studies postdoctoral fellow Dr. Clemens Harris points out that there were anxieties about a Black man using cocaine because: It was thought that his sexual libido kicked in, which made protecting white women very important. This was [a fear that was expressed during Reconstruction, too, as] lynching was supposedly a reaction to the sexual invasion of black males. The social movements of the 1960s–– feminist, civil rights, sexual revolution and later Black power––sought to turn the social order upside down. As the federal government increasingly expanded police power to deal with these issues, economically, the nation was going through deindustrialization, which negatively affected black communities. The symbols of urban crime

in America, social disorder, and the problem of the nation’s welfare state became that of black and brown people.

At the time, the War on Drugs was largely a way for the government to take a firm stance against increased crime rates associated with movements that heightened social unrest. It simultaneously aimed to ‘contain the racialized other’. This motivated the extreme categorization of marijuana, the zero-tolerance policies that accompany the War on Drugs and a targeting of minority communities. However, this does not mean that minority communities were actually the source of drug trafficking or consumption in the 1960s. Studies show that while Black people use marijuana at similar or less frequent rates than whites today, they are four times more likely to be arrested for such charges (Washington Post, “The Black/ White Marijuana Arrest Gap”). Starting after Nixon’s declaration of the War on Drugs, the prison population grew exponentially as the government adopted more extreme crime and punishment agendas. The prison population has since quadrupled from its size in 1980. This phenomenon is referred to as mass incarceration.

THE CORRELATION BETWEEN THE WAR ON DRUGS AND MASS INCARCERATION While the timing of the War on Drugs have led many to consider drug laws a primary contributing factor to mass incarceration, experts clarify that marijuanarelated arrests constitute a minuscule percentage of the prison population. However, marijuana laws do have a significant effect on who gets roped into the criminal justice system. As Penn political science professor Marie Gottschalk explains, “If we had locked nobody up on marijuana charges, we would still have a mass incarceration problem. Marijuana matters in a more complicated way because it has a spillover effect. Having a marijuana-related arrest on your record makes it likely that if prosecuted for any other crime, you would have a longer sentence. People being in the database makes them more likely to be looked at if a crime in the neighborhood happens. You miss it on mass incarceration if you just look at who is in prison serving time for marijuana charges, but who gets roped into the system through these charges is very significant.” Dr. Harris points out that decriminalization has greater implications than just legal change because, “it causes us to reassess our current law and order agenda that is rooted in the 1960s. We have failed to see that the issues are much more complex than what we initially ascribed them to be.”

“Studies show that while Black people use marijuana at similar or less frequent rates than whites today, they are four times more likely to be arrested for such charges.” THE HEALTH ISSUE / 7

WHO WANTS TO CONTINUE THE WAR ON DRUGS? DO YOU THINK MARIJUANA IS ADDICTIVE?!

Professor Gottschalk spoke about some of the hidden incentives for the police force to continue the War on Drugs, mentioning civil forfeiture laws as a prime example. These laws make it legal for officers to seize any property they think could be used in drug trafficking, from money to cars to houses. The government seizes millions of dollars from civilians without ever pursuing criminal charges. The value of the confiscated money or items is often less than a lawyer would cost to fight for it back. The possessed items or money go into a large unaccountable slush fund. The officers also target the traffic going south instead of north because southbound traffic usually contains money instead of drugs. The pharmaceutical indusry resposnsible for painkiller medications also benefit from the continuation of the War on Drugs because legalized marijuana would compete for their customers.

Percentage (%)

Yes, it's emotionally and physically addictive

Yes, it's emotionally addictive Yes, it's physically addictive

No it's not addictive

WHEN HIGH ON MARIJUANA I'VE EXPERIENCED...!

WHAT WE KNOW ABOUT MARIJUANA AND HEALTH

Done something reckless/dangerous Suicidal thoughts Panic Attack Skewed Sense of Reality Altered Perception of Time Inability to clearly express myself Talking More Talking Less Fear Paranoia/Conspiracy Theories Anxiousness Tiredness/Sluggishness Long Term Memory Loss Short Term Memory Loss Slower Cognitive Functioning 0

Percentage (%)

HAVE YOU EVER USED OTHER UNPRESCRIBED DRUGS? ! (ie cocaine, molly, mushrooms, acid, adderall, vyvanse?)

Yes, After Weed Yes, Before Weed Never

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In addition to the incentives certain groups may have to keep marijuana illegal, the strict regulations surrounding marijuana research have hampered the government’s ability to alter the initial scheduling of marijuana. Professor Owens explains that, “the federal government decided there was no acceptable medical use. That also means it becomes very difficult to research any possible medical impacts.” To obtain the drug legally, researchers must apply to and be approved by the Food and Drug Administration, the Drug Enforcement Administration, and the National Institute on Drug Abuse. A New York Times article titled “Medical Marijuana Research Hits Wall of U.S. Law” details the story of a University of Arizona professor who was stymied in her attempts to legally obtain marijuana for research on its potential to ameliorate post-traumatic stress disorder. She was subsequently fired from the university, which cited funding and reorganizational issues. The lack of formal research to disprove the non-research based scheduling of marijuana, as well as the administrative hoops researchers have to jump through, could be one reason why marijuana remains a Schedule I drug. Given that medical professionals are already utilizing the positive effects it can have, federally imposed limitations on further research unfortunately impede the discovery of new positive medical effects as well as how to limit harmful effects. In order to understand some of the more concerning effects marijuana can have, Penn students were surveyed about their experiences with marijuana and how they think it affects their health. The results suggest that the health threats of marijuana do not come from it causing people to do something dangerous to themselves

HOW OFTEN DO YOU USE MARIJUANA?! 35 30 25

Percentage (%)

or others, or even necessarily as a gateway drug, but from the possibility of it negatively affecting emotional stability, productivity and cognitive functionality. A study carried out by Professor Olivier Marie of Maastricht University in the Netherlands in April 2014 also suggests marijuana use worsens academic performance. A law was passed that banned students who weren’t from the Netherlands or bordering nations from buying cannabis at coffee shops. Since the law was short-lived, Marie was able to track students’ test scores before, during, and after the law was in effect. The results showed a clear increase in test scores for students that could not legally purchase marijuana, in contrast with those who could, followed by a resynchronization of test scores after the law was repealed. While this study does not fully isolate the variable in question, its results suggest that more research is needed to understand marijuana’s effects on cognitive functioning and productivity.

20 15 10 5 0

Never/Don't spend Never/Do spend time with users time with users

ENVISIONING REGULATIONS FOR LEGALISED MARIJUANA

Occasionally/Rarely Used to but not anymore

IN WHICH SITUATIONS DO YOU USE MARIJUANA?!

100

Spending time Feeling anxious Feeling anxious with friends at a about a personal about school party problem work

A HOLISTIC CONCEPTUALIZATION OF ‘COMMUNITY HEALTH’

Before bed

Doing something Watching TV/ Going to class/ creative movies, listening doing homework to music

IN WHICH OF THESE AREAS DOES MARIJUANA NEGATIVELY AFFECT YOU?! 45 40 35

Percentage (%)

Shifts at the local level towards more liberal drug laws indicate a change in the conceptualization of community health. Instead of viewing the pros and cons of certain drugs in just biological terms, political leaders are now taking into account a more holistic view of community health as something that includes a community unhampered by its ‘justice’ system. A society that almost exclusively punishes Black and Latino men for a crime of which they are not the primary perpetrators, prevents medication from getting to people who would benefit, cannot address the negative health effects of marijuana due to the lack of research, and causes further economic damage to already disadvantaged communities is not healthy. One of the most important things a people can do is acknowledge when it has failed, when it has acted rashly out of fear in an unstable time period, and re-evaluate its nonresearch based decision when the dust has settled. Only then can we see the defective systems we’ve built. -

Weekly

120

Percentage (%)

One possibility would be to regulate marketing around marijuana to reflect the reality of what we know about its health effects. Existing aggressive marijuana marketing campaigns in Washington and Colorado are attempting to move the image of marijuana users away from that of unproductive teenagers or conventional “pot heads” towards a middle-aged female audience, one that might even shop at Whole Foods. To hold marketing companies responsible and avoid the deceptive strategies used for cigarette and alcohol advertisements, more research is necessary so that these companies can responsibly convey accurate information.

Daily

30 25 20 15 10 5 0

School work Energy/focus in class

Emotional stability

Sober socializing

Socializing at Ability to fall parties on asleep marijuana

Maintaining friendships

Relationship with family members

THE HEALTH ISSUE / 9

HEALTHCARE HARRIES AND HOPES: A Call for More Reform Written By Aaron Wolff

r. Devi Shetty, called the “Henry Ford of Heart Surgery” by the Wall Street Journal, charges $2,000 for an average open-heart surgery at his flagship Narayana Hrudayalaya Hospital in Bengaluru, India. A similar surgery in the United States costs anywhere between $20,000 and $100,000. Narayana Hrudayalaya Hospital has 1,000 beds, compared to the 160 beds of the average U.S. hospital. Adjacent to Narayana, Dr. Shetty has built a cancer hospital and an eye hospital with another 1,700 beds between them. These high capacity hospitals allow Dr. Shetty to reduce costs by cutting out the middle-man to buy medical supplies directly from the suppliers. Dr. Shetty’s hospitals have a lower mortality rate than the average U.S. hospitals: the massive number of patients force surgeons to specialize in very specific procedures that help them develop a degree of expertise unmatched by many American doctors. Dr. Shetty recently opened a hospital called Health City in the Cayman Islands, which will make his low-cost health care available to Americans––many of whom cannot afford the high costs of American health care. Dr. Shetty’s operation is only one example of the many painful discrepancies between the American health care system and other methods of providing health care around the world. According to a study of various health care systems published in 2013 by the Commonwealth Fund, a private foundation that aims to promote better

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access to and higher quality health care, the United States has around fifty million uninsured and another thirty million underinsured (“vulnerable to high out-of-pocket expenses in relation to their income”) citizens. This is particularly concerning when compared to France, Germany, England, Canada, and several other more developed countries, which all have universal coverage. To make matters worse, health care in the U.S. is costly. The United States spends significantly more on health care (17.7% of GDP) than any other country. Surprisingly, the United States spends almost double the amount that countries like Italy and Japan spend, which both have substantially larger populations over the age of 65. This is odd because elderly populations usually account for a significantly higher degree of health care spending than younger populations. For example, according to a National Health Statistics Groups study, while citizens above the age of 65 comprise roughly 13% of the United States’ population, they account for 33.9% of health care expenditures. There are two distinctive characteristics of the United States health care system that help explain both the large number of uninsured Americans and high cost of health care in America. First, the American government only funds 46% of health expenditures, according to a 2012 report from the Organization for Economic Co-operation and Development (OECD) Health Statistics. According to the

“60% of adults with new coverage claimed they had seen a doctor or filled a prescription and 62% of those claimed they could not have afforded to do so before the ACA.” same report, the average OECD country funds 75% of health expenditures. This allows for a much larger safety net. Also, most OECD countries spend more on physicians and “acute care hospital beds.” Secondly, the United States health care system has more specialists, provides certain technology-dependent services, such as mammograms and MRI scans, at higher rates, and spends more on niceties like privacy and hospital space. This helps explain the high expenditure on health care. Stanford University emeritus professor Dr. Victor Fuchs argues that these problematic aspects of the American health care system are deeply rooted in the American psyche. America has a historical tradition of distrust of government, leading back to the American Revolution. Many immigrants came to America fleeing repressive governments, deepening the American suspicion of government. America also has an ethnically, religiously, racially, and culturally diverse population, especially compared to countries like Sweden, Norway, and Japan. People resent policies that take wealth away from them and redistribute it to others whom they perceive of as belonging to a different group. As Dr. Fuchs notes, this “stands in sharp contrast with redistribution within self-defined more homogenous groups,” like Jewish homes for the elderly and Mormon Relief Societies. Additionally, it is very difficult to pass legislation that could help mitigate the United States’ high spending and low coverage. The American political system’s set of checks and balances, expensive primary campaigns, long election campaigns, and the Senate filibuster all stand in the way of comprehensive health care reform by creating opportunities for special interest groups to block reforms they do not find agreeable.

Chetna Johri, Speaker Series Chair Wharton Undergraduate Healthcare Club

Recently, though, there was a massive attempt at reforming the United States health care system. On March 23, 2010, President Barrack Obama signed the Patient Protection and Affordable Care Act into law. This law, amended by the Health Care and Education Reconciliation Act of March 31 , 2010, is also known as the Affordable Care Act (ACA), or Obamacare. According to a National Conference of State Legislatures summary from March 2011, the ACA “intended to expand access to insurance, increase consumer protections, emphasize prevention and wellness, improve quality and system performance, expand the health workforce and club rising healthcare costs.” The ACA has been fairly successful at extending coverage to the uninsured and lowering healthcare costs. Since the first open enrollment period, according to a Commonwealth Fund survey, the uninsured rate for people between the ages of 19 and 64 has decreased from 20% in the July-to-September period in 2013 to 15% in the April-to-June period of 2014. Based on the survey, the Commonwealth Fund estimates that 9.5 million fewer adults are uninsured. Additionally, 60% of adults with new coverage claimed they had seen a doctor or filled a prescription and 62% of those claimed they could not have afforded to do so before the ACA. Additionally, in September of 2014, the Centers for Medicare and Medicaid services predicted that health spending in 2019 will be $500 billion less than they projected in 2010 before the passing of the ACA. Bloomberg News journalists Caroline Chen and Ian Katz state that “the law’s mandated program cuts and the medical practices it encourages––limiting unneeded procedures, and keeping people out of the hospital longer––are cited by economists as key ingredients in trimming the nation’s medical bill.” This is far from a perfect fix, as pointed out by opponents of the ACA, but it is a step in the right direction. Perhaps the future will involve large-scale provision of cheap health care, like that provided by Dr. Shetty. Our true hope lies in more health care reform. Whatever we do, change will require, to quote Dr. Fuchs, “attention to U.S. history, values, and politics.”

Imran Cronk, Vice President Wharton Undergraduate Healthcare Club

THE HEALTH ISSUE / 11

FOR ALL CITIZENS: The Right to Adequate Healthcare

veryone gets sick. Poor or rich, white or black, male or female, illness is as much a part of one life as another. When patients walk into hospitals, they expect to receive adequate care, but who expects that care to depend upon income, race or gender? Access to health care and quality of medical assistance in the United States has become increasingly dependent on such factors of an individual’s background. The United States Health Resources and Services Administration defines health disparities as “populationspecific differences in the presence of disease, health outcomes, or access to healthcare.” Studies conducted by researcher Margaret Whitehead and Health Canada, Canada’s federal department dedicated to overlooking health policy, have shown that there are twelve major factors that result in health disparities: (1) income and social status, (2) social support networks, (3) education, (4) employment and working conditions, (5) social environments, (6) physical environments, (7) personal health practices and coping skills, (8) healthy child development, (9) biology and genetic endowment, (10) health services, (11) gender, and (12) culture. Researchers and healthcare experts also agree that unaddressed language barriers, unclean water and polluted air, and inadequate access to fresh food and the Internet are all major contributors to health disparities. While all these factors can lead to health disparities, researchers cite income and race as the two major contributors to the unequal treatment of individuals in the U.S. Take Philadelphia as a case study for the impact of wealth on minority communities. The city is no stranger to disparities between the rich and poor; according to the Drexel School of Public Health, the poverty rate in the city is 24%, twice that of the national rate. Most of the area’s healthcare-related issues disproportionally impact lowincome and minority areas. Low-income families often live in old and deteriorating houses, which put them at risk for health conditions, and have reduced access to healthy, quality groceries. Consequently, poorer communities are more susceptible to diabetes, high cholesterol, stroke, and hypertension due to their reliance on cheaper foods with high salt and sugar content. These health disparities also stem from race. A study conducted by Rutger University’s Institute of Health, Health 12 \ IMPACT MAGAZINE

Written By Anissa Lee

Care Policy, and Aging Research professor Ayse Akincigil on depression diagnosis and treatment found that there were major discrepancies in treatment among various racial groups. Compared to 60% of African Americans and 63.4% of Hispanics, 73% of Caucasians received treatment for depression. While part of this discrepancy lies in the fact that minority patients are less likely than Caucasians to have private insurance that covers charges for mental health care, there are also differences in help-seeking patterns due to race and ethnicity. Akincigil reports that low-income African Americans were more likely to believe that mental health issues would improve on their own compared to Caucasians. Many of these low-income African American patients that sought treatment for depression mentioned that stigma, shame, and denial were all reasons why many members of their communities did not receive treatment. Another factor is biological: African Americans are less likely to present prominent mood or cognitive symptoms of depression, further complicating diagnosis of the disease by physicians. Income and race are intertwined, often playing a role in determining the care or lack of care that low-income, minority patients receive. According to the United States Department of Health and Human Services (HHS), lowincome patients are 65% more likely to lack health insurance as compared to high-income patients, due to the heavy cost of insurance. Research by the Commonwealth Fund, a foundation that supports research on health and social issues, showed that individuals who lacked health insurance were less likely to have a regular medical provider, seek medical care because of its high costs, receive appropriate care for their specific health conditions, or utilize preventive and screening services. Say Teresa, a low-income, minority woman, has diabetes, developed from years of unhealthy eating, which can be handled with treatment and regular medical visits. Teresa, who lacks medical insurance, may end up skipping a medical test or not filling a prescription for insulin because of the cost of these treatments. As a result, she suffers health complications due to the lack of treatment of her disease. Teresa’s story illuminates the struggle that 73% of low-income and uninsured adults face due to their financial backgrounds. As the United States population continues to grow, with racial minorities predicted to comprise 54% of the

U.S. population by 2050, existing health disparities will only worsen if left unaddressed. Moreover, these health disparities will have a heavy toll on the United States economy: researchers estimate that, between 2003 and 2006, the cost of these disparities in direct medical costs and lost productivity was more than 1.24 trillion dollars. Timothy Waidmann, a senior research associate at the Health Policy Center of the Urban Institute, estimates that Medicare alone spends an extra 15.6 billion dollars per year due to higher levels of untreated chronic illness among minority patients. There have been long-term efforts made by both individuals and organizations in addressing health disparities locally and nationally. The U.S. Office of Disease Prevention and Health Promotion has initiated the Healthy People 2020 campaign, which strives to achieve “the highest level of health for all people” by “[identifying] nationwide improvement priorities, [increasing] public awareness of and understanding of the determinants of health, disease, and disability and the opportunities for progress,” and “[engaging] multiple sectors to take action to strengthen policies and improve practices.” It aims to fulfill these objectives by integrating input from thousands of health experts and organizations and setting a 10-year goal for the United States to achieve. Global health insurance provider Cigna and other related organizations encourage healthcare providers and states to adopt datacollection standards that document and aid understanding of health disparities, collaborate with community organizations to reform current health plans to cover all necessary services for individuals, and provide interpreter services, to ensure smooth communication between non-English speaking patients and doctors. Perhaps the most viable option to fixing our health disparities problem lies in the implementation of Federally-Qualified Health Centers, or FQHCs. FQHCs, often situated in low-income neighborhoods with large minority populations, are large community health clinics that receive federal grants to provide primary care to underdeveloped communities. According to a 2013 “secret shopper” study conducted by University of Pennsylvania’s Leonard Davis Institute of Health Economics, FQHCs approved appointments to 80% of Medicaid beneficiaries compared to non-FQHC providers that only granted 60% of appointments. Penn Clinical Family Medicine and Community Health assistant professor Kent Bream echoed the importance of FQHCs: “We cannot begin to talk about tackling the problem of health disparities without fully recognizing the fundamental role that FQHCs are having in the healthcare community.” Ensuring that private plans fully cover FQHCs as safety-net providers will serve those who lack access and are most likely to be denied appointments at other providers. By addressing these health disparities and embracing viable solutions, such as FQHCs, we can have the discussions needed to draft public policies that protect and strengthen access to healthcare for all citizens regardless of income or race.

“

Low-income patients are 65% more likely to lack health insurance as compared to high-income patients, due to the heavy cost of insurance.

”

THE HEALTH ISSUE / 13

Written By Yuqi Zhang

BRIDGING A WIDE GAP: COMMUNITY HEALTH CENTERS AND FREE CLINICS IN WEST PHILADELPHIA A

ccording to the Robert Wood Johnson Foundation’s 2014 County Health Report, Philadelphia ranks lowest in the health outcomes of quality and length of life among all Pennsylvania counties. Social and economic factors, including education, employment rate, income level, and community safety, add to the complexity of community health issues in Philadelphia. While city government and the Philadelphia Department of Public Health (PDPH) have made some efforts to create a more efficient and effective public health system––most notably striving for accreditation from the Public Health Accreditation Board (PHAB) by 2015––stunted economic recovery over the past three years has cut into funds for public health demands. Furthermore, the 2014 Community Health Assessment administered by the PDPH reported that neighborhoods in West Philadelphia rank the third worst in the city behind the North and Lower North Philadelphia. To combat these health disparities, community health centers and free clinics have taken the lead in bridging the gap.

Community Health Centers and West Philly Community health is closely tied to socio-economic conditions. According to research, social circumstances and behavioral patterns determine 45% of a population’s health, a function of the combination of many factors, also including genetic predisposition, health care, and environmental exposure. Largely mired in destitution, and with high rates of unemployment and violent crime, neighborhoods in West Philadelphia see a great demand for affordable healthcare. As a result, community health centers (CHCs), which are local, non-profit or city-run primary care providers operated in medically underserved neighborhoods, have a strong presence in West Philly. 14 \ IMPACT MAGAZINE

“We have about 40,000 patients to serve in West Philly,” says Ian Bennett, Associate Professor of Family Medicine and Community Health, “most of whom are lower-income, quite a few of whom are uninsured.” Alongside his teaching at the university, Bennett’s work is closely tied to West Philly neighborhoods. One of the sites that Bennett works with is the Health Annex Center of The Family Practice & Counseling Network, a network of nursemanaged health centers providing primary health services to

“Social and economic factors, including education, employment rate, income level, and community safety, add to the complexity of community health issues in Philadelphia.” public housing residents, the poor, and the uninsured. This clinic, as a matter of fact, belongs to the Federally Qualified Health Centers (FQHC), which is part of the safety-net system supported by both the Democratic and Republican political parties. As an FQHC, the clinic receives grants from the federal government that help them to serve the uninsured. Since it is reimbursed on the basis of its cost, the clinic turns no patient away due to their insurance or financial status, charges by a sliding-fee scale based on individual’s ability to pay, and is governed by a community board, a majority of which must be the health center’s patients. Indeed, increasing affordable healthcare coverage is crucial to promoting community health in districts like West Philadelphia. And the presence of community health centers has a surprisingly positive impact on the local economy as well.

Student-Run Free Clinics In addition to the community health centers, student-run free clinics make considerable contributions to community health, filling the gap between quality medical care and the underserved population in West Philadelphia. For example, United Community Clinic (UCC), founded by a group of professors and students from the University of Pennsylvania, has been providing free medical services to residents in the Parkside neighborhood in West Philly for almost two decades.

“It is very comfortable for [people] to go to their local church basement. So we remove that barrier of feeling that they are going to the doctor.” For lower-income residents in Parkside, there are more barriers to primary care than one would usually imagine. First and foremost, insurance is a luxury for the jobless, and in some cases, even for the employed. Second, geography matters. For instance, Parkside is bordered by West Fairmount Park to the north, the Schuylkill River to the east, Mantua Avenue railroad tracks to the south, and North 52nd Street to the west. These geographic boundaries create significant transportation barriers and make it difficult for local residents to access medical services. Thus, the existence of UCC in the neighborhood is incredibly meaningful. One of the most fundamental goals of UCC is approachability. Situated in the basement of First African Presbyterian Church, a community center since the neighborhood’s earliest days, UCC becomes a bridge that connects the neighborhood to healthcare, both physically and psychologically. “We are not asking people to go to some clinical site, to Penn,” says Dr. Brian Work, internist at Penn Presbyterian Medical Center and director at UCC. “It is very comfortable for them to go to their local church basement. So we remove that barrier of feeling that they are going to the doctor. ” UCC opens every Monday from 6 to 9 PM. In the main clinic side, patients can take physical exams and receive primary diagnosis and treatment. For example, if diagnosed with hypertension, patients without insurance are referred to UCC’s hypertension clinic, which runs simultaneously in an adjacent area in the basement. Another important component of UCC’s service is social work. Patients receive counseling, help with insurance applications, and even housing applications when needed, since socioeconomic status and mental health are as important as physical health to one’s wellbeing. “I would say most of our work is social work, and our main goal is to make our patients get primary care eventually, as we are only temporary healthcare providers,” says Hallene Guo, 2014 College graduate and four-year UCC volunteer, to define UCC’s role in promoting community health. For students working at UCC, this unique experience is challenging, rewarding, and even transformative. “One of

"Largely mired in destitution, and with high rates of unemployment and violent crime, neighborhoods in West Philadelphia see a great demand for affordable healthcare." the things I love about UCC is that it’s so inter-disciplinary,” says Tanya Kahn, second-year medical student at Penn. Such a collaboration between undergraduate and graduate students from Perelman School of Medicine, School of Nursing, and School of Social Policy and Practice, under the guidance of preceptors from various disciplines, provides an unparalleled opportunity to understand healthcare in a holistic way. Student-run clinics like UCC are the seeds for the next generation’s initiatives in promoting community health and striving for equality. For Alexander Jordan, second-year medical student at Penn, working with UCC in Parkside has made him realize how difficult it is for the local population to access healthcare, which will have an impact on his future career. As Jordan quotes Dr. Eric Goren, co-clinic director of UCC, “If you don’t do community work now, you are not going do it when you start your career either.”

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Student Voices on Sleep: by the Numbers Written by Connor Boyle

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When asked “How much sleep does the average Penn student get?” the respondents answered an average of 6 hours per night, a full hour and three minutes less the actual average calculated from their bed and wakeup times. The most common response to “What keeps you from sleeping?” was, expectedly, schoolwork, with nearly 74% of respondents listing it as a culprit. Other reasons included extracurricular activities, spending time with friends, and procrastination. More than half (51%) of the respondents felt that they “didn’t get enough sleep” the previous night. A whopping 58% of students reported falling asleep in class within this semester; 26% reported this happening within the last week. A 2001 study by the University of Arizona Department of Medicine found a strong link between poor sleeping habits and reduced quality of life. These traits, such as difficulty falling asleep and excessive daytime sleepiness, are familiar to many Penn students. Groups like the NSF as well as the American Academy of Sleep Medicine corroborate these findings. Given our increasing understanding of the necessity of quality sleep, consider reworking your nighttime rituals. Giving in to that next Netflix episode might be costing you more than you think.

FREQUENCY OF ALL-NIGHTERS! 9%

Never

11%

Once a school year

35%

Once a semester

11%

Once a month Once every few weeks

13%

Once a week

21%

AVERAGE AMOUNT OF SLEEP PER CLASS YEAR! 7.8 Average Amount of Sleep (hrs)

hen did you go to bed last night? In an survey of Penn undergraduate students across every class and school, the average respondent reported going to bed at 1:45 AM and waking, roughly 7 hours later, at 8:48. This survey, aimed at assessing sleep behavior patterns among undergraduates at the university, was conducted over a two-month period and reached roughly 50 students across schools and classes. Recent research on human sleeping habits has contradicted the notion that there is a “magic number” for hours of shut-eye that you should be putting in each night. In a 2014 article, the National Sleep Foundation (NSF) advocated for a two-pronged approach in evaluating sleep needs. First, your sleep goal should be determined in part by your basal sleep need, which is defined as “the amount of sleep your body needs on a regular basis for optimal performance.” The second factor, sleep debt, is defined broadly as the “accumulated sleep lost from poor sleep habits, sickness, and awakenings from other factors.” Even if you meet your basal sleep needs of 7 hours tonight, you still may feel groggy tomorrow on account of your outstanding sleep debt from earlier in the week. What the average college student might not know is that long periods of sleep––9 hours or more––are actually a detriment to health in the long-term.

7.67

7.6 7.4

7.26

7.17

7.2 7

6.84

6.8 6.6 6.4

Freshman

Sophomore

Junior

Senior

Class

FREQUENCY OF NAPS! 8%

Never

13%

Rarely 11%

Once a month 2%

38% 13%

Once every few weeks Once a week Once every couple of days

15%

Once a day

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How much sleep does the average Penn student get? Average response: 6 hours Actual Average Penn Student Hours Asleep: 7 hours 3 minutes

NAPS ONCE A DAY

“Even if you meet your basal sleep need tonight, you still may feel groggy tomorrow on account of your outstanding sleep debt from earlier in the week.”

51% of students reported they felt they didn’t get enough sleep the previous night 58% of students reported falling asleep during class this semester 14% of all students reported falling asleep in class within the last couple of days 49% of students reported pulling an all-nighter at Penn at least once

Average Bedtime: Average Wakeup: Latest Sleeper: Earliest Riser: 18 \ IMPACT MAGAZINE

1:45 AM 8:48 AM 6:00 AM 7:00 AM

ALL-NIGHTER ONCE A WEEK

ON THE BLOG Continuing the Fight for Equal Rights: The Black Ivy Coalition by David Ongchoco Philly AIDS Thrift Looks to Penn Students by Kylie Maier Starting the Social Start-Up by Morgan Snyder The People’s Climate March by Julianne Goodman Truly Taking Control by Grace Jemison What even is Amendment 67? by Giulia Imholte Reviving Music Education by Melissa Lee Philadelphia’s “Actual Value” by Jennifer Preys Breaking Bread Together by Nicolette Tan Peter Singer Talks Effective Altruism by Nora Laberee Human Trafficking: Modern Day Slavery by Ciara Stein Street Art in Chile by Sam Friedlander Embracing Your Inner Argentine by Kelsey Williams …and more.

JOIN THE DISCUSSION: upennimpact.com

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Are What You Eat:

Written By Christine Hu 20 \ IMPACT MAGAZINE

The Changing Landscape of Diets and Nutrition

or the average diner, flipping through restaurant menus these days can feel like information overload. In the past, there might have been a solitary chili symbol next to spicy dishes, or a thumbs-up signs indicating the chef ’s specials. Today, not only do many restaurants post calorie counts, they also utilize a myriad of new labels––V for vegan, GF for gluten-free, DF for dairy-free, and so on. These labels have come about largely due to a rise in public consciousness of particular diets and eating trends. It is important to note that diets, eating trends, and eating disorders refer to very different phenomena and are associated with different habits. The broad term “diet” encompasses all types of eating habits—for example, those who have celiac disease may have no choice but to be on a gluten-free diet—but it is most commonly used in association with the aim of losing weight through calorie reduction, and this is the definition that will be used for this article. Eating trends are specialized eating habits that have gained mainstream acceptance; these trends may also have associated lifestyles (the Paleo diet, explored below, is a good example). Eating disorders, according to the National Eating Disorders Association, are conditions that involve “extreme emotions, attitudes, and behaviors surrounding weight and food issues,” and are associated with a loss of control over one’s eating behavior. Diets, eating trends, and eating disorders all involve decisions and behaviors related to food, albeit very different in degree and nature.

Diets: A Case of Cutting Calories

Diets, at their core, are about restriction––whether it’s carbohydrates, fat, dairy, or red meat, diets require followers to cut out certain types of food, or some number of calories. The idea of restriction is tied to that of excess. “Historically speaking, an overabundance of calories is not something that existed at a population level until about 40 years ago. This lends itself towards the appearance of all these different diets and fads,” says Nursing professor Dr. Bart De Jonghe. In the post-industrial age,

a combination of increased affordability, improved technology, and modern agriculture has resulted in the possibility of caloric overconsumption at the population level. Indeed, diets are a natural response to the desire to “look good” or maintain an ideal weight even as overconsumption becomes more prevalent. In 1992, Dr. Robert C. Atkins published Dr. Atkins’ New Diet Revolution, in which he detailed the Atkins diet, a multiphasic diet that sets quotas for the consumption of certain types of carbohydrates. Subsequent fad diets, such as the Zone, South Beach, and Weight Watchers diets, took varying approaches but were based on similar principles.

Eating Trends and Lifestyles: A Changing Perspective

However, these fad diets of the past have come and gone, and some of their successors are of a different mold. Eating trends like veganism, vegetarianism and the Paleo Diet (which the New York Times describes as “a nutritional regimen centered around pasture-raised meat, eggs, fresh fruit and vegetables, and nuts, in the spirit of our cave-dwelling forebears”) may appear to be limiting, but proponents argue precisely the opposite. “[When I began eating Paleo], I didn’t restrict my diet, I broadened it,” says John Durant, author of The Paleo Manifesto. “What’s not decadent about cacao, honey, coconut, pork belly and bone marrow?” College sophomore and co-President of the Penn Vegan Society (PVS) Brianna Krejci agrees. “I eat so many more foods now than before [I became vegan],” she says. “I had never tried Ethiopian food or Indian food before.” For Durant and Krejci, it seems that having clearly delineated rules for eating pushed them to be more creative in their culinary pursuits. Both the Paleo Diet and veganism are examples of eating trends that are closely linked with particular lifestyles. Durant believes it’s not just the modern diet that’s destroying our health, THE HEALTH ISSUE / 21

but also modern work and exercise habits. “A lot of people who start eating Paleo find that it creeps into other aspects of their life–– standing desks, minimalist running, dabbling in CrossFit or doing a Tough Mudder,” says Durant. The example of the Paleo lifestyle typifies a shift in the way people approach health and nutrition. De Jonghe observes that, until recently, “wellness” wasn’t part of the diet industry’s vocabulary. “The word ‘diet’ implies something temporary,” he says. “Wellness, [on the other hand], is a different way of approaching life, and is more sustainable.”

Eating Trends: A Recovery Aid Even as the industry shifts its focus to wellness, questions are still being raised about the relationship between seemingly restrictive eating habits and eating disorders, because specialized eating habits are still invariably linked to the goal of weight loss. Psychology doctorate student Amber Alhadeff believes that although such eating habits may work for some, they can also be indicative of deeper problems. “Food restriction, often the elimination of entire food groups, is extremely common in eating disordered patients,” she says. “Sometimes ‘restrictive diets’ can actually mask a true disorder.” However, changes in eating habits—such as following an eating trend—can also be used as recovery aids. “Becoming vegan got rid of all of my fears related to food,” says Krejci. “Every time I ate became an action that affected not just me, but the world.” Certified nutritionist Gena Hamshaw also writes on her blog Choosing Raw, “I had been steadily recovering from an eating disorder relapse, and veganism helped to propel my recovery forward.” For some, having some form of structure in their diets can help alleviate the sense of powerlessness that comes with an eating disorder, and lead the way towards recovery. Alhadeff believes the next step in recovery would be to gradually allow some spontaneity and flexibility in one’s eating habits. “This can be extremely liberating and is an important step in restoring a healthy relationship with food.”

“Every time I ate became an action that affected not just me, but the world.”

A Look at the Bigger Picture Any discussion of the relationship between humans and the food we consume is incomplete without a mention of environmental sustainability, whether in the form of sustainable farming practices, reducing agriculture’s carbon footprint, or simply reducing food waste. Whereas the diets of yesteryear promised a “drop in two dress sizes,” proponents of today’s diets emphasize not only personal wellbeing, but ethical and environmental concerns. This definitely resonates with Krejci. “I try to emphasize the holistic approach,” she says. “Going vegan is a choice that you’re making for everyone––for animals, for people, for yourself.” Durant is similarly optimistic about the impact Paleo can have. “If 5% of the population started buying pastured meat and eggs…the big producers would realize they can make a profit by adopting better practices,” he says regarding Paleo’s potential impact on humane livestock treatment.

We Are What We Eat–– So What’s Right for Us? Amid the multitude of diet books, advice columns, and commercial advertisements, making good choices can seem difficult and downright overwhelming. Add the element of environmental sustainability, and it’s no wonder that the world of diets and nutrition can seem vast and complicated. “It’s hard not to try different diets when there is so much nutritional misinformation out there,” says Marco Guevara, a Penn Vegan Society board member and a raw vegan. De Jonghe agrees, and believes that dietetics and nutrition should be given much more prominence in American education. “These are life skills integral to our basic way of living.” In this world of options, it’s important that we make choices that work for ourselves while being cognizant of the fact that how we eat also affects the world around us.

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A COMMUNICATION CRISIS: Suicide Prevention at Penn and Beyond Written By Sanna Wani

xperts at the Suicide Prevention Resource Center (SPRC), an organization supported by the Substance Abuse and Mental Health Services and Administration (SAMHSA), call stress a “risk factor”. It is, in fact, one of the most common risk factors of suicide, along with changes in environment, isolation and alienation, and a history of mental illness. However, the risk factors for suicide don’t necessarily develop in college. More and more students are entering universities with risk factors already in place, and the additional stresses of college act more as gasoline on an already lit fire.

WHAT UNIVERSITIES ARE DOING Suicide is the third leading cause of death among persons aged 15 to 24, accounting for 20% of deaths annually in this age group. More than a thousand of those deaths occur on college campuses. One in ten college students have made a plan for suicide, and about one in five have recurring thoughts. Thus, universities often seek funding and aid through SAMHSA and SPRC to create suicide prevention programs, and then integrate them into their student health services. What suicide prevention programs consist of varies. Most universities have utilized what SPRC calls the gatekeeper method: faculty and students can be trained to recognize the warning signs of students at high risk for suicide. Other universities deal with suicide prevention by trying to help their students eliminate risk factors by helping them learn how to deal with stress, remain connected to their peers, and generally interact with other people in a healthy manner. A culture of caring, cultivated by the above practices, is incredibly important to the process of eliminating risk factors because it addresses the life skills students need to heal themselves. The Worcester Polytechnic Institute (WPI) of Massachusetts enacted the Student Support Network as a part of their suicide prevention program. In it, students go through six weeks of training on opening up dialogue and fostering a better culture on the campus. Ohio State University (OSU) also has unique suicide prevention practices, like their R U OK? iPhone app for emergency crisis situations and their R U OK? Buckeyes fundraising event. Moreover, Victor Schwartz, the medical director of the Jed Foundation, a suicide prevention promotion organization specifically focused on college campuses, also explains how important it is for universities to promote their suicide prevention programs in tandem with their substance

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abuse programs and mental illnesses awareness programs as there is a great deal of overlap among the three. As Senior Campus Prevention specialist at SPRC, Kerri Smith, explains, effective suicide prevention is more than “just putting out massage chairs during finals.” Preventing suicide is more than just stopping stones from dropping into a puddle—it is emptying out the water.

WHAT MANY ARE AVOIDING Suicide prevention programs on university campuses rely heavily on one thing: how universities communicate about suicide. Universities can be cagey when communicating about suicide because they fear the ripple effect. The ripple effect is the idea that one change in society can broadly impact the surrounding social, physical, and/or mental environments. In the context of suicide, it is the idea that one suicide can spark others. The Cornell gorge suicides are often used as an example of the ripple effect of suicides. However, the ripple effect does not and cannot outweigh the importance of communicating about suicide. Krista Predragovich, a graduate student at OSU who heads several suicide prevention programs, such as Peers Reaching Out (PROSE), states, “[There is] still reluctance

“Suicide is the third leading cause of death among persons aged 15 to 24, accounting for 20% of deaths annually in this age group. More than a thousand of those deaths occur on college campuses. One in ten college students have made a plan for suicide, and about one in five have recurring thoughts.”

“I hate it when people call suicide a permanent solution to a temporary problem. Suicide is not a temporary problem—that kind of mentality doesn’t come from temporary circumstances.” on the part of universities as a whole to really appreciate the magnitude of the problem.” Universities cloak their comments under the blanket of mental health support and awareness, which is important in its own right but is not a suitable replacement for discussing suicide. This reluctance to approach suicide and have any sort of productive conversation about it may seep into the student population. If the university can’t talk about it, labeling it as too sensitive a topic, how will students learn the healthiest way to discuss it? Simply acknowledging the suicides isn’t enough; people need to know how to talk about it in a healthy, recovery-minded manner.

WHAT IS HAPPENING AT PENN The University of Pennsylvania has recently seen an increased focus on suicide after a series of painful losses to the student body. Public attention escalated with the suicide of graduate student and resident advisor, Wendy Shung, in August 2013. Her suicide was followed by four more: Alice Wiley in December of 2013, Madison Holleran in January of 2014, Elvis Hatcher in February of 2014, and Amanda Hu in September of 2014. In the same month as Holleran, Pulkit Singh died of an accidental overdose. In fifteen months, Penn lost six students. However, Penn has yet to enact a specific suicide prevention program. Last year, students took the initiative with the Penn Undergraduate Health Coalition (PUHC). PUHC brought together mental and physical wellbeing organizations at Penn in an effort to revitalize the system. The University of Pennsylvania itself also inducted several new panels for the health and wellbeing of the student body, such as the Task Force on Student Psychological Health and Welfare. But the administration of the university remains uncommunicative. Following Amanda Hu’s death, the administration received criticism from students and faculty on an email that implicitly functioned as a response to the suicide. The criticisms were that the email was too centered on Penn’s already in place “extensive network of support services on campus” and how it was jarring to push the responsibility of reaching out onto the student body. The issue of suicide itself is always very lightly skimmed and it is unclear whether this is to protect the student’s family or the university’s reputation.

WHAT WE CAN DO A long-standing truth is that shying away from these kinds of problems only fuels the fire. Emory University, located in Atlanta, is the first American university to release its suicide statistics through a program called “Emory Cares 4 U.” Students, faculty, and administration now engage in open discourse about suicide at Emory and how to better combat it. The community’s unified front against suicide is inspiring and has had a positive effect on the culture of Emory’s campus. Demonstrating this are remarks by Ahd Niazy, a sophomore at Emory: “Emory has so many resources for students who need emotional support—from nightly peer hotlines to professional counseling services— and all of the resources are heavily advertised to students and readily available…I think emotional health and comfort is really something Emory really strives to provide its students with.” This shows that there is great potential for growth and healing if Penn attempts to initiate further suicide prevention efforts. Health concerns have always required a sharp and straightforward approach. Suicide should not be exempt from this, as suicide is also part of public health. Ultimately, however, suicide prevention is more a process than a problem. Suicide prevention is more an effort than an act. Penn College junior and Reach-A-Peer Hotline (RAP-Line) President Antonia Diener wisely said, “I hate it when people call suicide a permanent solution to a temporary problem. Suicide is not a temporary problem—that kind of mentality doesn’t come from temporary circumstances.” Suicide is deeply tragic but we can’t let its tragedy horrify us: we need it to motivate us. Suicide prevention requires intense attention and careful consideration from every member of a community. Dialogue is vital, as it ensures one more person prevented against and preventing suicide, and that is, in all honesty, all suicide prevention is about. Counseling and Psychological Services (CAPS): 215-898-7021 215-349-5490 (Nights and weekends. Ask for CAPS counselor on call.) University Chaplain’s Office: 215-898-8456 Student Health Service: 215-746-3535 Division of Public Safety Special Services 24/7 Hotline: 215-898-6600 Division of Public Safety Emergency Communications Center: 215-573-3333 Office of the Vice Provost for University Life/Student Intervention Services: 215-898-6081

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Philanthro-fitness: Philanthropy with Benefits Written by Pallavi Wakharkar

ach year, more than 15,000 Penn State students get together for a 46-hour no-sitting, no-sleeping dance marathon known as THON Weekend. This is no regular college dance party: THON is the culmination of a year’s worth of fundraising and awareness for the fight against pediatric cancer. Since 1977, THON has raised more than $114 million for the Four Diamonds Fund at Penn State Hershey Children’s Hospital. THON is one of the biggest annual fundraising events in the country and a great example of a new type of philanthropy that blends exercise with a charitable cause. In a world of 5Ks for cancer awareness and zumba-thons for self-empowerment, exercise is becoming more and more connected with philanthropy. While more traditional forms of philanthropy involve an up-front donation of money, exercising for a cause means active work to raise money and awareness while doing something great for your own health at the same time. Organizations around the nation are creating a more engaged force of volunteers with philanthropic fitness, or philanthrofitness.

Girls on the Run: Philanthro-fitness in Philadelphia Girls on the Run (GOTR) is a local exercise-based organization that combines philanthropy and fitness to help young girls develop positive life skills in a group environment. “A girl on the run stands up for herself and for others,” states Colleen Kelly Howard, executive director of the Philadelphia branch of GOTR. Through a 12-week curriculum of combined lessons and exercise, GOTR coaches teach young girls about pressing topics like body image, while training them to complete a 5K run. The season culminates with this 5K, which represents their fitness and education journey. Additionally, the girls plan and execute a community impact project. Last spring, girls at the Norwood Fontbonne Academy collected recycled shoes to give to those in need. Howard reflected “It’s so exciting to watch [the girls] meet this goal which, at the beginning of the season, they couldn’t imagine being able to achieve.” GOTR coaches are people who love learning and making a difference in young people’s lives. As Howard describes it, “It’s 26 \ IMPACT MAGAZINE

not so much that our coaches are out there like track coaches with timers, but instead, they are encouraging and imparting confidence. The more the girls’ confidence builds, they more they realize that they can do it.” GOTR also features a program called SoleMates, the vehicle through which GOTR receives funding. SoleMates is a charity running program for adults; each SoleMate pursues an individual fitness goal. From running a half-marathon to completing a triathlon, SoleMates raise funds by asking their friends and family to support their training by donating to GOTR. This supports girls whose families need help paying the program’s registration fee. Being a SoleMate is an ideal option for someone who needs some extra motivation to reach his or her fitness goal. Through SoleMates, participants are able to improve their fitness while positively impacting a girl in need.

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Give Back and Get Fit on Campus But one doesn’t have to step off Penn’s campus to find philanthro-fitness opportunities, such as Greek fundraisers and wide-scale events like Relay for Life. Laura di Taranti, president of Penn’s Relay for Life initiative, has been relaying ever since high school. For di Taranti, Relay for Life started as a social event for a great cause, but soon gained personal significance. “I started out relaying freshman year of high school because it was huge in my hometown and all my friends were involved,” she explained. “Then, my sophomore year, my dad was diagnosed with testicular cancer. I relay for my dad.” Relay for Life, an annual event at Penn entering its tenth year, is held at Franklin Field on South 33rd Street. Attendance ranges from 850 to 1100 students. One of Relay for Life’s main fundraising events is called Get Fit Fight Back, a unique event founded in the link between exercise and decreased cancer risk. At Get Fit Fight Back, exercise instructors donate their time, teaching fun fitness classes like zumba or yoga. Students pay to attend these classes, and the money goes straight to the Relay for Life events. Di Taranti describes Get Fit Fight Back as “good for fundraising, because it

involves people paying for an actual service. People are likely to donate because they get something in return.” Thus, people pay for a service that they might have enjoyed anyways—but that money goes to a great cause. Greek organizations also use philanthro-fitness to fundraise. Penn sorority Chi Omega puts together the ChiOlympics every spring to benefit Make-a-Wish Foundation, which grants the wishes of children with life-threatening illnesses. Teams can participate in events such as relay races or tug of war, provided that each team member donates to the fundraising efforts. Penn fraternity Pi Kappa Alpha started up a new philanthro-fitness event on campus last spring Cycle for Life is an interactive spinning event held in Pottruck in memory of Taylor Trudeau, a Pike brother who passed away from leukemia. The Taylor Trudeau Cycle for Life’s mission is to raise money and awareness for leukemia, lymphoma, and melanoma. In a variety of ways, philanthro-fitness has allowed friends and student groups on campus to donate not only their money, but also their time and energy together.

Looking Forward:

The Future of Philanthro-fitness

Unsurprisingly, philanthro-fitness has also moved to the digital world of mobile phone apps. A team of economists at Yale University developed stickK, an app with a simple proposition: you either work out, or may be forced to donate to a charity you hate. There are apps that allow users to donate to their favorite charities, too. Run4Good, developed by the shoe company Saucony, is an app dedicated to combating childhood obesity. With every mile, runners earn money for community youth programs without having to enter a charity race or even open their wallets. At the end of the month, if the runner reaches his or her predetermined mileage goal, Saucony will double its donation to community youth programs, inspiring runners to meet their goals and working to reverse the adverse effects of childhood obesity. Runners can even collaborate on the 28 \ IMPACT MAGAZINE

app’s leader boards, joining teams that compete to run the most miles. According to Running USA’s 2012 State of the Sport, Americans are running at record paces, with the rise of charity runners fueling this surge. Additionally, Allied Business Intelligence (ABI) Research has predicted that the number of running apps will increase tenfold by 2016. Philanthro-fitness is sure to only become more popular, especially with technological elements making it easier and more beneficial to give. This movement has made selfless charity a little more selfish by helping individuals realize their personal fitness goals while also benefitting those is need. Every cent matters—and, in this case, every drop of sweat matters, too.

GIVE A SH*T

How Sanitation Saves Lives Written by Hannah Dardashti

Photograph from Penn Engineers without Borders, 2013 Cameroon trip to improve water distribution system THE HEALTH ISSUE / 29

as a toilet ever saved your life? According to Sylvia Matthews Burwell, former president of the Bill & Melinda Gates Foundation’s Global Development Program, “No innovation in the past 200 years has done more to save lives and improve health than the sanitation revolution triggered by the invention of the toilet.” More than antibiotics, vaccines, or the Pill, readers of the British Medical Journal voted in 2007 that the “most important medical milestone since 1840” was the introduction of clean water and sewage disposal. And yet, as Burwell laments, these incredible advances in health spurred by the toilet only reached one-third of the world.

750,000 CHILDREN die from diarrhea each year, directly related to poor sanitation

THE DANGERS OF POOR SANITATION

THE SPREAD OF DISEASE

Awareness of the relationship between poor sanitation, disease, and water has developed relatively recently. As the Industrial Revolution spread in the late 18th century, unprecedented masses of people moved to towns and cities. The intense crowding created prime conditions for the spread of infectious disease. In 19th century England, prompted by an epidemic of cholera, physician John Snow discovered that the disease spread through water. Social reformer Edwin Chadwick invented sewers rinsed with water, further illuminating the link between water and sanitation. In her 2013 TED Talk, Rose George, a journalist and author of the book The Big Necessity: The Unmentionable World of Human Waste and Why it Matters, explains how in our “flushedand-plumbed” world, we do not understand the horrifying toll of diarrhea. According to George, what is often the subject of adolescent jokes is actually “a very potent weapon of mass destruction.” She also elaborates on the perils of poor sanitation. Demonstrating a picture of a little boy openly defecating (“poo-pooing in the open,” in George’s own words) she explained, “Well, that little boy will not have washed his hands. He’s barefoot. He’ll run back into his house, and he will contaminate his drinking water and his food and his environment with whatever diseases he may be carrying by fecal particles that are on his fingers and feet.”

Diarrhea is caused by gastrointestinal infections from microorganisms that are mostly “spread by contaminated water.” George’s example of the little boy illustrates the World Health Organization’s (WHO) claim that “water contaminated with human feces, for example, from municipal sewage, septic tanks, and latrines is of special concern.” It often results in loss of bodily fluids, especially in children. The WHO elaborates that other water-related diseases, such as cholera and dysentery, cause “severe, sometimes life-threatening forms of diarrhea.” The spread of infection occurs through poor personal hygiene, and interaction between contaminated water, as in irrigation, and food sources, such as fish from polluted waters. People in the developing world are especially susceptible to diseases related to lack of sanitation that are transmitted through water. According to WHO, 8.5% of deaths in Southeast Asia and 7.7% of deaths in Africa are caused by diarrhea. Today, as reported by the Gates Foundation, 2.5 billion people, or 40% of the world’s population, “practice open defecation or lack adequate sanitation facilities.” Another 2.1 billion people “use toilets connected to septic tanks that are not safely emptied, or use other systems that discharge raw sewage into open drains or surface waters.” Nearly three-quarters of a million children die each year from diarrhea, which is directly related to poor sanitation.

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“LET’S TALK CRAP” Access to water is essential for improving sanitation. In Target 7.C of its Millenium Development Goals, the United Nations (U.N.) set a two-pronged goal, addressing safe drinking water on one hand, and sanitation on the other. The U.N. aimed to “halve, by 2015, the proportion of the population without sustainable access to safe drinking water and basic sanitation.” According to WHO, “People with access to clean and convenient sanitation services also experience greater dignity, privacy, and security. This is especially true of women and girls, who often miss work or school when they are menstruating and risk sexual assault when they are forced to defecate in the open or use public restrooms.” While the safe drinking water goal has been met “five years ahead of schedule,” the U.N. reports that sanitation goals continue to lag. Environmental Studies professor Stanley Laskowski worked for the Environmental Protection Agency (EPA) for 31 years and continues to work on water-related issues. According to Laskowski, somewhere between 2,000 and 4,000 children die from water-related issues every day. While the U.N.’s Goals are “easy to understand” and “quantifiable,” Laskowski states that the U.N.’s definitions of water access may not be what we imagine them to be; according to the U.N., access to water would mean walking from Penn to 30th Street Station and carrying back 20 liters of water per person. Laskowski also described a hesitancy to address sanitation, accounting for its lagging progress. According to Laskowski, no politician wants to do a “ribbon cutting at a latrine.” Rose George also alluded to this neglect of the issue in her Ted Talk by boldly and humorously naming her talk, “Let’s talk crap. Seriously.” Recognition of the problems around water and sanitation is growing in tandem with efforts to combat them. In 2011, the Bill & Melinda Gates Foundation launched its strategy “to help bring safe, clean, sanitation services to millions of poor people in the developing world.” The strategy identifies sanitation as “a neglected area” in which “significant change” can be made.

“ ” People with access to clean and convenient services also experience greater dignity, privacy, and security.

A key element of the Gates Foundation’s strategy is providing grants to support “innovative approaches and technologies” that would positively impact sanitation in developing countries, especially in cities. Another example of increased recognition is the World Economic Forum’s inclusion of “water supply crises” as one of its Top 5 Crises. Since first appearing in 2012, problems relating to water have moved up in rank each year, peaking at number three this year. Laskowski encourages students to get involved. His class, “Global Water Issues” (ENVS 637-660), visited the U.N., presenting proposals for new goals. “This is a major environmental health problem globally,” he tells students, “and if you really want to make an impact, you can consider this as your career path.” Laskowski emphasizes that “you don’t have to be an engineer to pursue such a path. [Experts] say it’s 25% engineering and technical, and 75% everything else: knowing the culture, addressing gender issues, setting up a financing system…All those things are as important as the technical aspects are.” Improving sanitation conditions, increasing access to clean water, and reducing disease constitute a threepart endeavor that requires the collaboration of many global partners. Laskowski highlights that, even as college students, it is possible to play a part in this significant project—if we are not scared to start talking dirty.

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Beyond Abortion:

Broadening the Scope of Women’s Health Written by Leora Mincer

omen’s health. It’s an incredibly charged term, bringing to mind angry protestors brandishing pictures of fetuses, Wendy Davis filibustering the Texas State Senate for 11 straight hours to block a bill restricting abortion access, and the famous (or infamous) Supreme Court Hobby Lobby Decision that exempted employers, on religious grounds, from including contraception in their employees’ health insurance plans. But, as tends to be the case with politically explosive realms, the real story is far more complex. Women’s health encompasses a variety of issues, ranging from ovarian cancer to eating disorders to date rape to postpartum depression. While the media constantly highlights the various ethical, medical, and legal debates tied to reproductive rights, it devotes much less attention to other avenues of research and activism that fall under the umbrella of women’s health. In fact, the Philadelphia and University of Pennsylvania communities feature a plethora of organizations and academics devoted to studying women’s health from a wide range of perspectives. There is a growing sense in the health fields that women have long been neglected in medicine, both as providers and as recipients of healthcare. The program FOCUS on Health & Leadership for Women, at the University of Pennsylvania Perelman School of Medicine, strives to both promote women’s health research and the 32 \ IMPACT MAGAZINE

recruitment and advancement of women at all levels of Penn Medicine. “FOCUS pushes to improve the position of women as medical professionals,” explained FOCUS Executive Director and Perelman School of Medicine professor of Emergency Medicine Dr. Stephanie Abbuhl. She noted that while 50% of medical students are female, women comprise only 20% of full professors at medical schools nationwide. At some point, men begin advancing more quickly than women. Thus, in addition to providing programming intended to help women in the medical field build networking or leadership skills, FOCUS’s team also analyzes existing research in the hopes of understanding practices and environments that best promote women’s advancement. This research, Dr. Abbuhl emphasized, sets FOCUS apart from women’s leadership programs at other medical schools, and is an integral part of women’s health research. FOCUS also promotes research to better understand the female body, supporting work in an emerging field called “gender-specific medicine”. This field puts a “gender lens” on every imaginable medical issue, including heart attacks, kidney disease, and cancer. Dr. Abbuhl explained that while men’s and women’s organs are quite similar, there are also differences which researchers are just beginning to

appreciate because, until recently, clinical trials were largely conducted with only white males. Many medical professionals and academics assert that women’s neurology has also not received enough attention. Just as research is now discovering differences between men and women’s physical health, it is important to understand sex differences in behavioral health, posited Dr. C. Neill Epperson, a Perelman School of Medicine professor of psychiatry and director of The Penn Center for Women’s Behavioral Wellness (PCWBW). She cited as proof the statistic that migraines and rheumatory arthritis are much more common in women than in men while neurological disorders that appear early in life, like autism and attention deficit disorder, disproportionately affect men. Dr. Epperson explained that the long neglect of women’s mental health has prevented a deeper understanding of many of the challenges women face throughout their lives. The reproductive events in a woman’s life influence her neurology; menstruation, pregnancy, and menopause can all trigger new or alter pre-existing mood disorders. “A lot of behavioral specialists don’t understand the female endocrine system,” she asserted. “We [the researchers at PCWBW] are unique in really understanding their hormones’ stress systems.” She emphasized that the key is to analyze both female hormones and the various environmental factors that impact women. For example, postpartum depression tends to affect women much more than men, both because of hormonal shifts and because of environmental factors ––namely that women are generally more involved in birth

and childcare, and are thus more affected psychologically and psychiatrically. Understanding all of the stressors and factors allows Dr. Epperson and her colleagues to help women handle the various challenges they encounter at different stages of life. But some claim that the health of women cannot be addressed solely by conventional medicine. Proponents of the natural birth movement say that promoting women’s health requires changing the way birth happens in America. The Philadelphia Alliance for Labor Support (PALS), an organization focused on birth outcomes, consists of doulas, people who are trained to provide support during labor and after birth. Certified PALS doula Cathy McCormick explained that PALS provides free doula services for lowincome women who want a natural birth experience or support during the birth process, but would not otherwise be able to afford it. They also provide subsidized certified doula training to members of the Penn and Philadelphia communities. These doulas seek to give women educational, emotional, and physical support during pregnancy, labor, and immediately after birth. According to McCormick, hospitals do not consider women’s emotional health during birth, and treat them “as though they are on a conveyor belt,” leaving the women feeling powerless. Doulas are there to make sure women have some control over the labor process. McCormick asserts that latent misogyny in society denies women their right to give birth in the manner that is most natural and best suited to them. She also blamed

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“According to McCormick, hospitals do not consider women’s emotional health during birth, and treat them ‘as though they are on a conveyor belt,’ leaving the women feeling powerless.” the “corporate takeover” of most hospitals, claiming that hospitals nowadays see birth as lucrative and don’t consider the emotional effects of certain practices on women. Abbuhl, Epperson, and McCormick come from very different backgrounds and approach the field of “women’s health” in different ways, yet they all believe it has farreaching applications. As Dr. Abbuhl put it, “The health of women is not just about disease, it’s about wellness.” The healthier and more successful women are, the more they can contribute to society. In their eyes, women’s health isn’t just about women ––it’s about everyone. Dr. Abbuhl noted that men also benefit from understanding the best practices for advancing women’s careers, as well as the unique differences between the presentation, diagnosis, and treatment of the same illnesses in men and women. Dr. Epperson explained that her work studies not just women, but the interplay between gender and sex. While a person may be born with a brain that is more stereotypically “masculine” or “feminine,” how the person is treated and what societal expectations are set for him or her also affects brain chemistry. Understanding how a person’s physiology reacts to different environmental factors may shed light on the hazy relationship between sex 34 \ IMPACT MAGAZINE

and gender, and the differences that may or may not exist between the sexes. And McCormick argued that the effects of a positive birth experience stretch far past the actual hours of labor. When a woman can feel empowered after birth, knowing that she was a part in the decision-making process, her role as a mother, relationship with her children, and contributions to society will be positively impacted. Ultimately, all of these individuals and groups firmly believe that the health field, as it stands today, does not adequately address or incorporate unique female needs. When considering this diverse assortment of approaches to “women’s health,” one cannot help but wonder why there is so much focus solely on reproductive rights. Perhaps it is because they are tied up with deeper political and religious implications. Perhaps it is because they make for better headlines. These discussions of reproductive rights are certainly important and integral to our society, but it may be the time to expand the mainstream understanding of “women’s health.” Only then can we engender a dialogue about medicine, health, and wellness in all its forms that is far more nuanced than the stale and repetitive one we so often hear today.

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