Spring Insider 2021: Global Health Solutions

CONTENTS Modern But Traditional pg 2

Saltman Quarterly

Volume 16 | Spring 2021

Contested Illnesses pg 6

GLOBAL HEALTH SOLUTIONS

COVER ILLUSTRATION BY SHAE GALLI

Exhale and Exhaust pg 3

Loss in a Pandemic pg 4

High School Essay Contest: Superbugs pg 7

GETTING TEK-SAVVY

MODERN PROBLEMS REQUIRE TRADITIONAL SOLUTIONS

n March 26th of this year, Japan witnessed its earliest cherry blossom season in almost 1,200 years, according to data collected by Osaka University. To put that in perspective, the last time cherry blossoms bloomed this early was around the time that gunpowder was invented.

Unfortunately, this preliminary pink phenomenon is most likely yet another sign of shifting climates across the globe. The NASA Global Climate Change record outlines that the average temperature on the Earth’s surface has risen approximately 2.12 degrees Fahrenheit since the late 19th century; this is largely due to industrial carbon emissions, with much of the warming occurring over the past 40 years. Other symptoms of Earth’s fever include ocean acidification, rising sea levels, and record numbers of extreme weather events. Some of the impacts of climate change can be seen and felt presently, such as economic loss from strains on outdated infrastructure, increased risks and costs of agricultural production due to lack of quality and quantity of water, as well as increased health risks from wildfires or ground-level ozone pollution. However, marginalized populations who lack the economic resources to effectively react and adapt are the ones hardest hit by climate change, and many are already feeling the effects.

For Indigenous communities reliant on natural resources for their economic, cultural, and physical well-being, climate change poses a distinctive threat.

Along Louisina’s Gulf Coast resides the Houma tribe, a historic Indigenous people with about 17,000 enrolled tribal citizens. A case study examining the effects of climate change on the United Houma Nation tribe conducted

by Shanondora Billiot, Assistant Professor of social welfare at Arizona State University, found that the Houma are especially vulnerable to environmental changes, such as rising seas levels and erosion, because they inhabit a region that is mostly covered by water and marshland. About 25 Houma families live in Isle de Jean Charles, a strip of land in the bayou of immense cultural significance that has shrunk considerably from erosion and saltwater incursion. The once 22,000 acre island now spans a fraction of that size at just 320 acres. Without considering the ancestral importance that still ties some of the Houma to the isle nor how the sinking of the isle is the direct result of inadequate climate change policy, state officials proposed a $48 million resettlement project that would relocate the island inhabitants to a new community 40 miles north, a plan that was not coordinated with Houma

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written by Max Gruber

photo by Bridget Spencer tribal leaders and echoes of historical resettlement programs where Indigenous communities were forced into undesirable lands. Additionally, the federal government refuses to recognize the United Houma Nation as a sovereign tribal nation and as such disallows them from the legal authority to create their own environmental protection policies—yet there is a perpetual lack of Indigenous representation in state and federal politics. Billiot asserts that this legislation only reacts to the problem rather than addressing underlying root issues like climate change. Due to tribe members’ experience with institutionalized racism and ostracization, some Houma forgo participation in climate change-adaptation activities and lack spaces to speak out against this discrimination.

Despite such tribulation, many Indigenous communities are fighting for political and climate policy change while simultaneously adapting traditional lifestyles to truncate environmental damage. Traditional Ecological Knowledge, or TEK, refers to the practice of using Indigenous knowledge and technology to create locally based, community-driven, non-industrialized methods as protection from climate change.

In California, the Karuk tribe uses traditional burning practices to limit forest fuel buildup and prevent severe wildfires. The Coast Miwok are working with the National Park Service to pro-

tect cultural sites from erosion and flooding and to document sites predicted to be lost. In Northern India, the Khasi tribe have guided rubber fig trees to develop living bridges and ladders in their villages, allowing their infrastructure to better resist the area’s monsoons over time rather than degrade like artificial infrastructure. Subak, or terraced agricultural surfaces of the Balinese, maintain high soil and water quality through coordinated planting schedules and shared water.

Many Indigenous communities are also active in social movements for climate change planning to prevent environmental destruction; for example, Aboriginal and Torres Strait Islander people in Australia are advocating for the construction of emergency seawalls and reducing carbon emissions.

By incorporating TEK into adaptation strategies, Indigenous communities can resist climate change autonomously. Centering Indigenous voices in the discussion surrounding climate change can help create public policy that recognizes cultural differences and better supports the needs of such communities. The conversation of climate justice can’t exist without the larger context of the historical repression of Indigenous communities, but understanding the reality of tangible solutions based on ideas such as TEK is crucial in creating a difference in the communities that need it the most.

SQ INSIDER

EXHALE & EXHAUST Factors and Features of Environmentally Triggered Asthma written by Helen Zhu

ommuters might say that driving on the highway, the monotony of the road going on forever and the droning of car engines, hardly makes for a particularly enjoyable sensory experience. Even worse is highway traffic: as the cars slow to a lethargic crawl, the idling engines lead the smell of smoke and smog through the vents of your car to prickle your nose until you are forced to hurriedly press the air recirculation button on the dashboard. For many, the unpleasant sensations and pollution of the highway are limited to the duration of the commute.

However, due to the close proximity of highway construction to homes, this intrusive and harmful pollution is a constant presence in every breath of everyday life for thousands.

The infrastructure of the highway and freeway system in the US was delineated using the red-lining maps developed by the Federal Housing Association and real estate developers in the 1930s. These maps coded zones according to the perceived risk that banks would take on if they gave loans to aspiring homeowners in the area: neighborhoods designated as “red” or “hazardous” represented the highest risk, and individuals from these areas who attempted to take out a loan to purchase a home outside their community were often denied. This process, known as “redlining,” often targeted communities of color and was the primary tool for housing segregation. In the 1950s, urban renewal plans such as the National Interstate and Defense Highway Act allowed governments to take private property from designated redlined zones for the public construction of new highways. This meant that individuals in these redlined communities, often communities of color, were subject to either physical displacement or hazardous air pollution from greatly increased traffic.

Thus, choices in physical infrastructure led to environmental inequality, where environmental health hazards and risks are stratified across lines of race and class. Another example of environmental inequality is from the consequences of corporate manufacturing plants: waste and air pollution continue to fall disproportionately on low income communities and especially on black, brown, and indigenous communities.

Legislation that prioritizes wealthy corporations with the expense of environmental harm to specific populations’ residents only reinforces racist, colonial representations of people of color and their health as unimportant.

photo by Sam Zilberman

Highway construction and the traffic-related air pollution (TRAP) it causes around urban residential areas has led to increasing rates and risks of asthma, marked by lung inflammation, spasms, and mucus. When particulate matter and gaseous pollutants like ozone or nitrogen dioxide are respirated, irritants introduce airway inflammation and hyperresponsiveness. Residing by major highways results in regular exposure to pollutants and causes the chronic constriction of these airways. Furthermore, gaseous pollutants can act as oxidizing agents, which can overwhelm the lungs’ antioxidizing enzymes to cause oxidative stress—these effects are also associated with the development and exacerbation of asthma.

A local example of environmental racism can be seen in Barrio Logan, a neighborhood in south central San Diego with a large Latino population. According to the Intersectional Health Project in San Diego, Barrio Logan was delineated by 1930s redlining and was consequently vulnerable to urban highway construction legislation. In the 1950s, the residential Barrio Logan was redistricted as a mixed use zone, which opened up the land and property for govern-

ment and private construction. Barrio Logan today contains an oil-processing center, a Navy shipyard, and, most notably, Coronado Bridge and the Interstate 5 highway. This industrialization and the pollutants that came along with it still drastically affect the health of Barrio Logan’s residents: in Barrio Logan, there are about 81 visits per every 10,000 people to the hospital for asthma, a rate higher than 92.9% of other zip code areas across California. To combat the effects of this environmental racism and protect future generations, we must reduce future air pollution.

Reducing TRAP generation can decrease residential exposure and the impact of asthma on urban communities of color like Barrio Logan. The Barrio Logan Monitoring Project, implemented by the Environmental Health Coalition, has been impactful in accomplishing this here in San Diego. This project provides residents with outdoor air monitors, indoor air filters, and filter monitors to measure particulate matter exposure inside homes. This data has helped residents in community planning efforts to reroute traffic away from residential.

Monitoring the effectiveness of this plan and others is important to holding cities continually accountable to addressing and eliminating environmental inequities in terms of traffic-related air pollution.

Understanding how legislation has created environmental inequities allows for recognition and action against the resulting health disparities that disproportionately risk the lives of communities of color. Neighborhoods like Barrio Logan have a vibrant and rich culture despite the adversities they have faced, and it is imperative that future research and regulation both address the root causes of morbidity and present solutions accessible to the most affected individuals.

Vol. 16 | Spring 2021 | 3

EXPERIENCING LOSS IN A PANDEMIC rief. A complicated, yet fundamental part of the human experience. For many it’s not something that they talk about. It’s not something that most people even know how to talk about. However, amidst the countless losses COVID-19 has brought about this year, it’s something that so many have no choice but to talk about. Whether it was the loss of a loved one, loss of a job, or loss of a lifestyle, the disruption exists nonetheless and everyone experienced some form of it this year.

Losing someone is a life-altering experience. There exists a before and after that is truly unexplainable. In a single moment absolutely everything has changed. That’s not something that’s easy to come to terms with, especially right after it happens. A part of what’s made grieving bearable are the rituals we’ve incorporated into the cultures of each of our societies. For many, processing the loss is as simple as visiting your old favorite places or having a drink in your loved one’s honor. For others, a memorial or service allows the reality of the situation to come into light for them. Rituals are powerful: in them lies healing. Studies conducted by Dr. Ede Frec-

ska and Dr. Zsuzsanna Kulcsar have shown that grieving rituals have the ability to allow the body to release endorphins that contribute to the healing process by reducing anxiety, emotional distress, and physical pain.

At some point in our lives, we’ve all heard of the five stages of grief: denial, anger, bargaining, depression, and acceptance. Not everyone experiences each of the stages in this particular order, but ultimately we pass through each one in our own way. However, with the limitations the pandemic has brought upon us, processing grief in our normal ways has been detrimentally affected.

The ceremonies we hold after the passing of a loved one allow us to accept what has happened and overcome our denial. With the pandemic and its unimaginable mortality rates during its peak, funeral homes were overwhelmed to the extent that many families weren’t given an opportunity for a service, denying mourners a key element of the human grieving process: accepting their loved ones’ departure. There were even instances this past year where it felt like loved ones were refused the basic respect of a

final resting place, even by forces of nature, like the accumulation of bodies that floated in the Ganges River in India. These unpredictable and horrendous occurrences can directly fuel the second stage of grief, anger. Couple this with the guilt many families experienced as they watched their loved ones in pain and were completely unable to offer help they could have provided in different circumstances. These intense situations alter every stage of the grieving process.

All of this can lead to an individual’s feelings of grief failing to fully resolve. According to DSM-5, Persistent Complex Bereavement Disorder is a condition many individuals experience after loss where the grief they experience is much longer, more intense, and much more significantly disruptive to their life. Even though there aren’t risk factors that cause it, most that experience it feel the way they do due to some form of denial of their grief. Without further treatment and care, it can bring about some dangerous outcomes for the sufferer as their mental health and overall wellbeing deteriorates.

We need to become better at addressing grief. Grief is one of those horrible things that, despite its inevitability, is often ignored or brushed over in our fast-paced world. We don’t discuss grief extensively or publicly, leaving us unprepared when we are faced with trying to overcome its challenges. Among all of the hardships the COVID-19 pandemic has brought us, grief is the one that is being spoken about the least. Grief is a lonely journey each mourner has to embark on by themselves, but knowing that they have a few people fighting for them goes a long way. If you know someone who is grieving, reach out to them and express your care in an intentional way by listening or by showing up for them when they need it. It may seem little or unimportant, but the smallest acts of love for someone who is suffering truly does go a long way.

written by Andra Thomas photo by Anne Marie Berry Editors-in-Chief: Andra Thomas, Salma Sheriff Editor-at-Large: Arya Natarajan Head Production Editor: Julia Cheng UTS Production Editor: Nicole Adamson Production Team: Zarina Gallardo, Tania Gallardo, Amber Hauw, Ashley Chu Media Director: Sanjana Sharma

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Research Editors: Nikhil Jampana, Noorhan Amani Online Editor: Anjali Iyangar SQ Features Editor: Ingrid Heumann UTS Features Editor: Shreya Shriram Staff Writers: Max Gruber, Helen Zhu, Andra Thomas, Juliana Fox Head Illustrator: Sara Kian

Staff Illustrators: Shae Galli, Yichen Wang Head Photographer: Sam Zilberman Photographers: Bridget Spencer, Anne Marie Berry, Jasmine Jung Head Tech Editor: Juliana Fox Tech Editors: Kaz Nuckowski, Max Gruber, Ishrak Ramzan, Anushka Bajaj, Smriti Variyar, Megha Srivatsa

Vol. 16 | Spring 2021 | 5

SQ INSIDER

STRUGGLING TO BE SEEN THE CLINICAL INVISIBILITY OF CONTESTED ILLNESSES

written by Juliana Fox xam Room 1. A gaudy green table sits in the middle of the room. My palms sweat against its slick material as I lift myself up, the movement accentuated by the harsh crackle of the waxy paper as I sit down. My feet dangle aimlessly off the side. I feel small, like a child.

“The doctor will be right in to see you, alright?” More of a statement than a question, punctuated by the soft click of the latch as the nurse exits.

I nod my consent at the closed door, eyes remaining glued to the checkered floor. Anxiety pulses through me as the seconds tick by, and goosebumps raise on my sticky, flushed skin.

Minutes later another click, followed by a rush of noise from the hallway. My eyes snap up; a young woman stands in the doorway—her pristine white lab coat matches a wide smile as she extends her hand. “You’re...” she pauses, eyes flitting down to her chart.

“You’re Juliana, yes?”

I went to the doctor that day after weeks of persistent chest pain—after weeks of weighing whether a potential diagnosis was worth yet another experience of having my symptoms completely dismissed. I knew what my doctor would tell me; random bouts of body pain and fatigue are symptoms to be expected from my fibromyalgia diagnosis. When I asked for tests, she informed me that regretfully there were no tests available to confirm symptoms of fibromyalgia. She explained to me that tests for heart conditions would be excessive as fibromyalgia patients are often just “really stressed”, then she walked out the door to her next patient.

I, like many others, suffer from what is called a contested illness. According to Conrad and Barker’s “The Social Construction of Illness”, a contested illness is one “where sufferers claim to have a specific disease that many physicians do not recognize 6 | sqonline.ucsd.edu

photo by Jasmine Jung or acknowledge as distinctly medical”, like fibromyalgia, chronic fatigue syndrome, and chronic Lyme disease. Most contested illnesses are tied together by two common threads: first, there is little to no understanding of their biological basis; second, both medical professionals and the patients themselves often question the authenticity of the presented symptoms.

But where does the concept of a contested illness come from? At the heart of the issue lies the emerging distinctions between symptom-based diagnoses and testbased diagnoses. In “When Do Symptoms Become a Disease?,” Robert Aronowitz

examines how recent advancements in biology and medicine have laid the groundwork for a distinctive shift in the perception and treatment of diseases. While physicians previously focused on symptom-based diagnosis—relying mainly upon self-reported symptoms from patients in order to achieve a diagnosis—they have recently instead favored test-based diagnoses, in which identification of the biological underpinnings of a set of symptoms leads to a diagnosis.

Undoubtedly, there are innumerable benefits to this test-based diagnosis process; however, an emphasis on this single

mode of diagnosis raises a new problem: what happens when the biological basis of a disease is not yet understood, such that there are no tests available that can confirm a diagnosis? Aronowitz describes how the invalidation of symptom-based diagnosis has left a subset of poorly-understood diseases neglected. The resulting issue is a systematic separation of patient and physician experience within the clinical setting, with patient experiences being undervalued in favor of medical testing. Many who suffer from fibromyalgia and other contested illnesses are unable to achieve the validation, support, and resources that a diagnosis should provide, leading to intrusive feelings of invalidation.

I can still distinctly recall the way that this pervasive doubt colored my initial diagnosis; as doctors questioned me about everything from my symptoms to my diet, I remember the fear that seeped into my thoughts.

With each doctor that visited, I questioned myself more. Many nights, even now, I lay in bed, head swimming as my body floods with searing pain from injuries that have long since healed; what keeps me awake in many cases is not just the discomfort but the paralyzing doubt in my own reality and senses.

In spite of the struggles faced by many individuals with contested illnesses, there is still hope on the horizon. As the downfalls of over-emphasizing test-based diagnoses have become more salient within our culture, increasing advocacy has subsequently produced improved awareness. On the medical side, continual advancements in science and the biological basis of disease inch closer towards shedding light on the underpinnings of these conditions. While there is, undoubtedly, still a long way to go, these developments on both the sociological and biological levels give me hope that we are approaching a time when “contested illness” is nothing more than an obsolete term of the past.

SUPERBUGS:

A GLOBAL THREAT n Twilight of the Idols, Freidrich Nietzsche dramatically acclaims that “what does not destroy me, makes me stronger.” Unbeknownst to him, Nietzsche had identified a phenomenon evident in numerous biological processes. One notable example is that of acquired antibiotic resistance, the evolution of bacterial strains to withstand drugs that once eliminated them, a prominent topic of discussion amongst public health experts, physicians, and international leaders. Exacerbated by the overuse of antibiotics in medical and animal agricultural industries, the proliferation of these “superbugs” severely threatens the health of our globalized society. Particularly vulnerable are marginalized communities disadvantaged by financial circumstances and a lack of reliable health-promoting resources.

The emergence of resistant bacteria in response to the overuse of penicillin during the 1940s was a byproduct of natural selection. Organisms with mutations that protect them from the hazards of their environment tend to thrive.

This was the crux of Darwin’s theory of evolution by natural selection. A single bacterium may spontaneously evolve a resistant mutation which can then be transferred via phages, lysis, or plasmids to neighboring bacteria. Unfortunately, this captivating dance of genetic adaptation became accelerated by human activities.

A significant factor was the over-prescription of antibiotics in medical facilities. According to the Centers for Disease Control and Prevention, 30% of antibiotics prescribed in the United States are unnecessary. When adjusted for inappropriate selection, dosing, and duration, the figure rises to an astonishing 50%. Additionally, patients may use prescribed antibiotics improperly by failing to follow instructions for duration and dosage. This can result in failed treatment and necessitate more expensive and invasive therapies.

The animal agriculture industry is also largely responsible. 80% of the antibiotics sold in the United States go to stimulate animal growth—not even to treat or prevent illness.

The inappropriate introduction of antibiotics allows for existing bacteria to develop the aforementioned resistance. These traits inevitably proliferate to cause widespread genetic change amongst highly transmissible microorganisms like Staphylococcus aureus and Streptococcus pneumoniae.

The apocalyptic ramifications of antibiotic resistance have already gripped the public, threatening global health. By reducing the efficacy of traditional treatments like penicillin, physicians are often forced to utilize stronger

SQ HIGH SCHOOL ESSAY CONTEST MEGAN HAUBRICH

and more expensive medications. This has magnified global health care inequality by FRED C. BEYER HIGH SCHOOL rendering necessary therapies less affordable. Similarly, countries with inadequate In the seventh annual High School Essay access to clean water and lack of sanitation Contest, the SQ Community Outreach team systems suffer worse outcomes. The World asked high school students to write a 500-750 Health Organization asserts that over 2 word piece about a global issue affecting the billion people rely on drinking water taintworld today and its connection to biology. ed by feces and human-born pathogens.

Coupled with the lack of soap-and-water SQ hopes this experience will encourage and handwashing stations, infections requiring celebrate science communication among professional intervention are inevitable. future scientists and inspire them to think Unfortunately, the promises of the medical about biology in a broader context. mantra “first, do no harm” do not always materialize. Between 1995 and 2008, over 15% of patients in low and middle-income countries acquired at least one additional infec- options, thus decreasing the burden of antibiottion each hospital stay. In addition to endanger- ic resistance on developing countries and those ing global health, commercial and sustenance financially hampered. Additionally, innovative animal agriculture may suffer declining pro- methods of reversing antibiotic resistance are ductivity when faced with outbreaks of antibiot- emerging. Researchers at UC San Diego, for ic-resistant infection, potentially threatening the example, have developed a gene drive which food security of dependent populations. Groups inactivates the resistance gene on a plasmid at with already unstable food supplies can face an efficiency 100 times greater than traditional malnourishment, a general contributor to poor CRISPR technologies. health. These challenges threaten to increase By refusing to surrender to these “superglobal morbidity and mortality rates concerning bugs,” humanity will indisputably manifest infectious disease, jeopardizing disadvantaged Nietzsche’s philosophy, for what communities. doesn’t kill us can only The severity of these outmake us stronger. comes prompts a critical quesantibiotic tion: what can we do to mitigate the consequences of antibiotic resistance? On an individual level, abstaining from improperly using these medications is of primary importance. This ina single bacterium with a resistant cludes taking antibiotics only mutation as prescribed for bacterial illnesses. Stopping treatment preresistant mutation can be transferred via phages, maturely or skipping doses makes lysis, or plasmids to medications less effective and provides neighboring bacteria an opportunity for resistance to develop.

In addition to individual efforts, a multitude of widespread reforms must occur. This includes enforcing stricter regulations on antibiotic use and a global bacteria collaboration to address develop antibiotic underlying issues of inadresistance equate access to healthcare, water, and sanitation facing vulnerable populations. Tending to these needs would diminish the spread of resistant bacteria while increasing treatment

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