Public Health Advocate Fall 2017 by UC Berkeley Publications and Media Center

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PUBLIC HEALTH ADVOCATE FALL 2017

PIECING TOGETHER THE TRUTH 8

HEALTH AND TECHNOLOGY

NATIONAL SPOTLIGHT

Big Data, Big Prospects

Innovative Policies in Action

IN THE COMMUNITY

Human Trafficking in the Bay Area

LETTER FROM the EDITORS Dear readers, In times like today, when the press and media are challenged and well-established research is discredited, there is no issue more critical than defending and preserving what we know to be true in the field of public health. Stories that are biased, sensationalized, or simply untrue compete for our attention in our daily intake of information. We as student writers have a duty to not only identify impartial or deceptive content and seek out facts, but also to generate content that exposes and spreads essential information backed by primary and reputable sources, evidence, and data. Our Fall 2017 print edition contains a compilation of articles regarding everything from international politics to health policy to environmental health. Despite the vast variety in article topics, one common thread remains—they all bring light to the truth. Whether increasing awareness of human trafficking in our local communities, or discussing rampant hate crimes and their detrimental health effects on minority populations, all of our writers highlight important public health-related issues. In these disconcerting times when reality and scientific facts can often be convoluted, we’re piecing together the truth, one puzzle piece at a time. After all, we acknowledge that the most empowering way to advocate for public health issues is to deliver the stories that piece together an honest and unbiased truth about some of the most pressing issues our society faces. So please peruse, scrutinize, fact-check, discuss, and debate topics brought up in the following articles. We promise you: They’re not fake news. Sincerely, Elizabeth Li and Jasmine Tatah editors-in-chief

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STAFF

EDITORS-IN-CHIEF Elizabeth Li

Jasmine Tatah

PRINT MANAGING EDITOR Joy Suh ONLINE MANAGING EDITORS Brandon Chu

Zoe So

BUSINESS MANAGER Vedaja Surapaneni DECAL FACILITATORS Elizabeth Li Vedaja Surapaneni

Jasmine Tatah Christine Lum

LAYOUT EDITORS Brandon Chu Shaina Desai Vivian Hong Surina Khurana

Alisha Mehdi Priya Roy Pamee Sapasap Heather Zhang

CONTRIBUTING WRITERS Sofia Andrade Hannah Luong Usef Awnallah Chigozie Maduchukwu Bradi Bair Dhruv Mandal Harsimran Bajwa Alisha Mehdi Shaina Desai Nick Murdock Natalia Garban Anna Nguyen Jessica Garcia Kameswari Potharaju Vivian Hong Amanda Reilly Jordan Keen Elise Rio Surina Khurana Priya Roy Kristal Lam Pamee Sapasap Lesly Ann Llarena Kayley Vaid Heather Zhang

TABLE OF CONTENTS 4

Meet the Editorial Board

Laying the Foundations: Health Infrastructure

Beyond the Pretty Packaging

Big Data, Big Prospects

The Children of Domestic Violence

Ramen for Dinner: The Harsh Reality

Unseen in the City: India’s Urban Slums

Human Trafficking in the Bay Area

Oakland’s Industrial Pollution

Silent Contaminant

More Money, More Problems

To Dream or Not to Dream: Dreams and Your Health

Housing the Homeless

Dealing with Disability

Malnutrition in the Orphanage

CO2 Emissions in Southeast Asia

Innovative Policies in Action

Music for Your Brain: Harmful or Helpful?

Language Barriers in Health Care

Clothing-Induced Pollution: A Rising Threat

Social Media and Food Trends

Nightlife and Nationalities

Expense of Hate Crimes the

PUBLIC HEALTH ADVOCATE // 3

MEET THE EDITORIAL BOARD

ELIZABETH LI CO-EDITOR-IN-CHIEF

Vedaja Surapaneni is a third-year Molecular and Cell Biology major. This is her third year with the Public Health Advocate, and she is excited to continue working with the publication next semester. Outside of PHA, Vedaja is involved in small-RNA packaging research and implementation research targeted towards patients with COPD.

Elizabeth is a fourth-year Public Health and Media Studies double major with a minor in Public Policy. She’s most interested in mental health, communications, and health policy — specifically with regards to suicide prevention. She loves napping, baking cheesecakes, and going to Kauai, and has enjoyed lead facilitating the PHA DeCal in her last semester of undergrad. After she graduates this December, she will work in tech and pursue an MPH in epidemiology and biostatistics.

VEDAJA SURAPANENI BUSINESS MANAGER

Joy is a second-year intended Public Health major. She is involved in infectious disease research on urinary tract infections with Dr. Lee Riley’s lab and serves on the UPHC Research Committee. In the future, Joy hopes to continue conducting research on infectious diseases as a medical doctor. In her free time, she enjoys watching nature documentaries, writing short stories, and spending time with family and friends.

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Brandon is a second-year intended Public Health major and Public Policy minor. When he is not busy managing PHA’s website, Brandon heads a committee with the Cal Undergraduate Public Health Coalition and works at UC Berkeley’s Institute of Urban and Regional Development to research links between city planning and public health. In the future, he hopes to influence public health policy.

PRINT MANAGING EDITOR

JASMINE TATAH CO-EDITOR-IN-CHIEF

Christine Lum is a fourth-year Public Health major and chemistry minor passionate about chemistry, poverty alleviation and global health. Aside from managing the Advocates for Public Health DeCal, she is involved in structural biology research, is a teaching associate working with international students, and leads a Bible study for Cal Christian Fellowship. She hopes to become a physician and pursue global medical mission work in the future.

BRANDON CHU ONLINE MANAGING EDITOR

JOY SUH

ZOE SO ONLINE MANAGING EDITOR

Jasmine is a fourth-year majoring in Molecular and Cell Biology and minoring in English. She is involved in innate immunity research and helps lead the PHA DeCal and an Access to Medicines DeCal. She plans to continue working in research or biotech before applying to MD/PHD programs in infectious diseases. When she’s not cramming for exams, she enjoys running, hiking, baking and creative writing.

CHRISTINE LUM DECAL MANAGING EDITOR

Zoe is a third-year pursuing a major in Public Health and a minor in Public Policy. In addition to managing PHA’s extracurricular teams, Zoe is doing research on health care market consolidation and has interned at multiple nonprofits around the Bay Area. Next semester, she will be travelling to Australia and the Solomon Islands to conduct field research on environmental and community health in remote coastal villages.

LAYING THE FOUNDATIONS HEALTH INFRASTRUCTURE by

DHRUV MANDAL contributing writer

would be to democratize health and provide patients with up-to-date medical services. A huge development would be to funnel existent funds into new technology to help organize patient information. In addition, the “brain drain” in the Middle East due to refugee migration places the maintenance of health services at a disadvantage. Public health practice would also dictate that health services be tailored specifically to the individuals affected by tragedy. Sending UN panelists to discuss social systems would help improve understanding of transgenerational trauma as well as launch services to treat said trauma. Contacting key donor and relief agencies would help humanitarian organizations agree on resource mobilization and donor strategies. Once initiated, such plans can lay the foundations for an effective financing framework that can mitigate the transitional challenges. In speaking with State Department Diplomat of Residence Dorothy Ngutter from Berkeley, CA, the need to help these territories is greater than ever. “We have to understand that current solutions introduced in conflict-ridden territories like the Middle East have been ineffective,” she says. “And at a time where the future where the Middle East hangs in the balance, the biggest improvement we can make to their health systems is structure, not supplies.”

t can be very easy to overlook resources in our world that seem ubiquitous. One establishment constantly taken for granted is hospitals — the driving force behind public health advocacy. However, while our accessibility to everyday health services is terrific, the same cannot be said about the world over. Armed conflict from territorial, political, and religious disputes has affected numerous countries all over the world, most notably in the Middle East and parts of Africa. In specific, the growing civil conflict in Syria between the government and rebel groups have caused socioeconomic turmoil such as the lack of food, internal displacement, forced migration, and destruction of infrastructure – more specifically, health infrastructure. Health infrastructure involves the distribution of services through a system that relies on healthcare facilities. During times of conflict, this pipeline of services becomes damaged because healthcare workers flee, hospitals face structural damage, and medical resources run low. Additionally, the low number of healthcare workers who remain may have a difficult time training new students; this often leads to inadequate medical education. Poorly planned emergency response, inefficient use of funds, and mistakes from nongovernmental organizations (NGOs) can also exacerbate the rebuilding process. With monetary measures and manpower falling short, Dhruv is a first-year from Marlboro, New Jersey. In additon to the solution to this crisis might lie very simply in using writing for The Public Health Advocate, he is involved in UC public health to set up a long-term structure. One goal Berkeley’s Suitcase Clinic. the

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Beyond the Pretty Packaging What’s really hiding in your cosmetic products According to the Campaign for Safe Cosmetics, the laws that govern beauty products are very limited. In fact, known carcinogens are legally allowed in commonplace any of us use some form of cosmetics cosmetics. The FDA has minimal power in regulating or personal care products. Whether beauty products’ ingredients, according to the Harvard it is simply shampoo or School of Public Health. While some the latest makeup trend, chemicals are listed on the cosmetic labels, we constantly put these products on our one of the most toxic chemicals found in The average bodies — often without giving it a second beauty products, phthalates, are not legally American is thought. However, the cosmetic label is required to be included and are often exposed to perhaps something to pay more attention hidden in the label as merely “fragrances.” to. According to the Center for Disease more than 100 Furthermore, companies can use the labels Control and Prevention, chemicals can chemicals from “all-natural” and “organic” according to their indeed be absorbed through the skin. interpretations of the definition. personal care Furthermore, Amy Roeder at the Harvard While some experts suggest that what School of Public Health explained that in the we really need is more regulation of the products. United States alone, the average American beauty industry and transparency of the is exposed to more than 100 chemicals from implications of exposure to the ingredients personal care products simply while getting ready in the in cosmetic products, it is also interesting to analyze morning, many of which can be detrimental to one’s this issue from a consumer’s perspective. Several college health. While some chemicals found in body wash and students at UC Berkeley and UC Davis offered their shampoo like sodium lauryl sulfate have minimal effects perspective on cosmetic product safety and what they such as causing allergies or irritation, other products have look for when shopping. Their questionnaire responses been linked to more serious conditions. For example, reflect a diversity of knowledge and opinions. formaldehyde, commonly found in hair smoothing For example, some students reported paying the products, has been linked to asthma and menstrual most attention to price, quality, availability, and brand disorders. Not surprisingly, the list of potentially harmful name when it comes to their product choices. In terms chemicals is quite lengthy. of considering ingredients, one student mentioned If it is known that these chemicals are toxic, why are being cautious about triclosan and triclocarban—toxic they allowed to be sold as if they were perfectly harmless? chemicals known to be present in products such as by

SOFIA ANDRADE contributing writer

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antibacterial soaps and toothpastes. Yet another said said: “I don’t really think I have access to alternate that she tries to find more natural products given that products that have less toxic chemicals. Usually it is the some deodorants have aluminum and moisturizers may price that ultimately makes me buy an affordable beauty contain hydrogen peroxide, a bleaching product.” Another respondent brings up agent and disinfectant. an interesting perspective on accessibility, However, most of the participants pointing out that looking at the label takes People care expressed a lack of knowledge about the extra effort. “Monetarily I do have access more about ingredients in their cosmetics. Several said to [safer] products. However, I am too looking good that they were not aware of toxic chemicals lazy to do the research and seek them out, in cosmetics at all, and one explained that than the future unfortunately.” although she is aware that there are harmful Furthermore, it is important to consequences chemicals in cosmetics and prefers “allunderstand the intersection between social natural” products, she would not know associated with determinants of health and public health, specifically which ones to avoid. She reflects, the chemicals of and what this means in terms of equal access “I think that if there were more posters the product they to safe cosmetic products. For example, and infographics that put up the specific although everyone who uses cosmetics is are using. names of chemicals to avoid in products, exposed to these harmful toxins, a recent that would be helpful. If this was located in study published in the American Journal the beauty section of stores this would be of Obstetrics & Gynecology suggests that most effective, but I can imagine that [it would be useful women of color are exposed to more chemicals in to make] it a part of general health education classes.” cosmetics due to racist beauty standards and the products Another student agrees with the need for education: that are advertised to women of color. “I think understanding how chemicals affect my skin As many of the interviewed students mentioned, it would make me pay more attention. Simply looking at is also valuable to consider the cost of safer products ingredients doesn’t give me a good understanding of how and whether everyone has equal ability to easily afford they affect my skin.” and access them. It’s important to take all of this into Yet another questionnaire respondent said that they consideration as we work toward addressing this public would not change their makeup choices unless there were health issue and minimizing the risk of exposure to high-quality alternatives without harmful ingredients. harmful chemicals. Along those lines, one student makes an important point about society: “I think a lot of people don’t pay attention because they don’t care. In a society where Sofia is a second-year student intending to double major in image and beauty is prioritized, the product and what Psychology and Social Welfare. She is interested in learning it offers becomes more important than the chemicals about the social determinants of health and is passionate present. People care more about looking good than the about addressing social inequalities and health disparities, future consequences associated with the chemicals of the particularly in the realm of mental health. She hopes to combine product they are using.” this with her interest in clinical and developmental psychology. In part, access to safer products depends on whether She has always enjoyed writing and loves exploring these people are willing and able to pay for them. One student areas of interest in her articles for the Public Health Advocate.

the

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Big Data, Big Prospects

hat if the cure to cancer could be found in numbers? Over the past several years, “big data” has taken over almost every industry. The increased accessibility of advanced collection methods have allowed for the aggregation of massive data sets describing virtually every aspect of our lives. The raw representation of our behaviors can then be used to create applications that shape the modern world. Google search algorithm references users’ histories to deliver customized results. Investment and banking firms use predictive modeling to provide early warnings for security fraud. The Social Security Administration processes historical information to detect potential fraudulent claims. The healthcare industry is notorious for lagging in innovation. Healthcare is constantly criticized for being resistant to change, falling years behind other industries in adopting technological advances. Data has been no different for the industry. Despite the large volume of information being collected from clinical trials, medical records, and insurance claims, health care professionals have not fully embraced the potential of big data to decrease costs, increase efficiency, and ultimately, save lives. Pioneers have begun to adapt data analytic methods towards improving provider care, individual health outcomes, public health, and clinical biomedical research. This groundbreaking work has paved the way for the modernization of the field, and will lead to the introduction of more advanced applications in the future. 8 \\ FALL 2017

ANNA NGUYEN contributing writer

Individual Health Access to a patient’s aggregated medical data allows medical professionals to provide better preventative care. With the passage of the Health Information Technology for Economic and Clinical Health Act in 2009, the Department of Health and Human Services is able to create programs that encourage the adoption of electronic health records, while also promoting best practices for private, secure health information exchanges. Blockchain technology allows for sensitive data, such as electronic health records, to be shared within a decentralized private network. Healthcare blockchain provides a way for physicians to securely access and modify a patient’s medical records in real time. Predictive modeling and machine learning methods are then used to screen a patient’s symptoms, medical history, and environmental factors, and send early warning signals if they detect irregularities. These methods can also recommend accurate diagnoses and suggest effective treatments, improving the quality of care that a health practitioner can provide. Healthcare Providers Big data can be used to prevent fraud, waste, and abuse to effectively manage hospital operations, while also decreasing the cost of care. While hospital budgeting is a complex process, predictive modeling can be used to accurately estimate hospital admissions and care demands, allowing administrators to allocate staff in ways that reduce both wait times for patients, and hospital wage costs.

Predictive analytics can also be applied to prevent diseases that certain populations may have. insurance fraud. By processing large sets of This particular application is crucial historical claims, an algorithm can detect to modern cancer research. Clinical abnormalities in an inaccurate claim and flag Technology has researchers are able to measure changes in a it as fraud. The Centers for Medicare and the potential to cancer genome over time, to determine the Medicaid Services use predictive analytics mutation of a particular gene and potential in this way to detect fraudulent claims in make the world drug targets. As a result, the research a healthier ways that could not be done with traditional community has a greater understanding of assessment methods. Implementing this place. It is up to the inner workings of cancer and access to system saved the Centers over $210.7 more research data. the healthcare million over the course of a year. industry to Digital health has just seen its start. The Public Health and Medical Research either embrace integration of advanced data collection and Overwhelmingly large volumes of patient analysis methods is changing the way that its worth or be data are game-changing in understanding the healthcare system operates. Medical left behind. population health. Big data cleaning practitioners and healthcare managers will and processing allow epidemiologists to be able to increase efficiency and lower costs cross anonymous datasets collected from by shifting their focus towards personalized insurance claims, patient medical records, and hospital preventative care. Clinical researchers will be have a admissions with environmental factors to determine the deeper understanding of both individual and population risk or presence of an outbreak. Epidemiologists may also health, allowing them to develop innovative treatments use comparative data to find causal relationships between and more effective medications. various environmental exposures and prevalence of Technology has the potential to make the world disease. Access to this data allows researchers to gain a healthier place. It is up to the healthcare industry to valuable information about a population without the either embrace its worth or be left behind. variability that may arise in the traditional method studying a small sample, and could help determine the effects of any confounding factors on health outcomes. The rise of genome coding has produced data at an exponential rate. Data processing techniques allow Anna is a second year student majoring in Public Health and researchers to parse through the unsorted data to make Data Science. She is interested in the fields of biostatistics and conclusions about DNA sequencing and its effects on epidemiology and hopes to apply emerging data analytic tools disease. The ability to analyze thousands of sets of genome to policy review and health research. In her free time, Anna data would contribute to the understanding of genetic enjoys hiking, discovering new boba shops, and watching dispositions to infection and reveal vulnerabilities to videos of really fluffy dogs. the

PUBLIC HEALTH ADVOCATE // 9

THE CHILDREN OF DOMESTIC ABUSE

omestic violence is a serious issue that has reached epidemic proportions globally and nationally in the United States. Hence, the month of October is dedicated to Domestic Violence Awareness. In the United States, domestic violence affects 10 million people per year. The effects of domestic violence encompass both direct effects such as physical injury, unwanted pregnancy and abortion, and low birth-weight for babies as well as indirect effects like emotional trauma and behavioral problems, which are equally if not more harmful. Additionally, domestic violence is associated with elevated rates of depression and suicidal behavior in affected individuals according to the National Coalition Against Domestic Violence. Domestic violence does not only affect the adults involved; it also has a detrimental impact on the children of those families. Statistics from NCADV show that one in 15 children in the United States are exposed to domestic violence every year and 90 percent of these children witness the violence firsthand. “Domestic violence affects children because it perpetuates the cycle of violence,” says Eileen Ollivier, the Program Director at YWCA Berkeley/Oakland. “Children who grow up in homes with domestic violence have difficulty developing social skills, feel alone, and have a hard time trusting adults.” According to a 2009 study conducted by Scott E. Carrell at the University of California, Davis and Mark L. Hoekstra at the University of Pittsburgh, children who experience violence at home tend to develop mental and behavioral issues such as depression, increased anxiety, aggressive behavior, decreased social competence, and a decline in academic performance. The study explains how children who experience domestic violence exhibit behaviors that severely impact the learning of other students. These children often disrupt the classroom dynamic by interrupting the teacher and preventing other students from learning. Children who are exposed to domestic violence may in turn exhibit violent behaviors 10 \\ FALL 2017

HANNAH LUONG contributing writer

towards their peers. These troubled children often attend the same schools as other academically-disadvantaged students. Thus, the effects of family circumstances on student behavior and performance in the classroom is a concern for schools and the local communities as it has the potential to negatively impact the education and life outcomes of many students. Carrell and Hoekstra’s study shows how constant disruption in the classroom results in lower math and reading test scores. Subsequently, these test scores translate to lower rates of college attendance and completion. Due to their struggle to obtain and complete a college education, these students often earn lower wages later in life in comparison to students who graduate from college. Hence, the achievement gap widens in communities where domestic violence is prevalent as the cycle of poverty perpetuates. Fortunately, some schools have implemented counseling for students who experience domestic violence. Children who receive guidance from counselors develop strong bonds with them and behave better in class. These counselors focus on understanding their students’ situations at home and provide a safe space for them to talk about their experiences. “The main issue for these children is the isolation they feel,” says Ollivier. “We have to rebuild their trust and healthy relationships with adults to help them build healthy relationships later in life.” “Raising awareness on the situation helps survivors to speak out and provides them with a safe space to escape from violence, ending the cycle of domestic violence.”

Hannah Luong is a second-year undergraduate student intending to major in Public Health and minor in Education. She lives between two cities: Berkeley and San Francisco. In her free time, she likes to read novels and water her plants.

Ramen for Dinner: The Harsh Reality by

BRADI BAIR contributing writer

came to college with hopes and dreams of staying up late, cramming, drinking exceptional amounts of caffeine, and eating my bodyweight in top ramen. In high school, that idea was glamorized: I looked forward to that experience, of being the “broke college student”. What I never imagined was the harsh reality that awaited so many of my peers: literally having ramen, or nothing, to eat. In the 2014 UC Undergraduate Experience Survey, 20% of UC students reported skipping meals to save money “somewhat often” or “often”. At the number one public university in the world, these bright, world-changing students are forced to choose rent, tuition, textbooks, and more over eating. So, what does food security look like, why are so many students food insecure, and what is the campus doing to mitigate this problem? One student organization working to address this issue is Swipe Out Hunger, a group that organizes the Donate a Grocery Bag Program in the dining halls and raises awareness about food insecurity in collaboration with other campus organizations. Halle Redfearn, their co-president and co-founder, shared that food security goes beyond the data from the Undergraduate Experience Survey. “[This] number does not reflect the type of food students often resort to as their ‘meals’,” she says. “Food insecurity is about both the accessibility and quality of food available.” Like Swipe Out Hunger, there are many organizations and individuals working on campus to reduce food insecurity amongst students. The UC Berkeley Food Pantry offers emergency food supply to all UC Berkeley students, and the Berkeley Student Food Collective provides an affordable outlet for UC Berkeley community members to purchase local, healthy products. Additionally, the Basic Needs Committee brings together

student, faculty, and community leaders to address the pressing challenges food insecurity presents for students. An article in the Cal Alumni Association’s California Magazine highlights the traumatic experiences of food insecure students on Berkeley’s campus. These students are often forced to skip meals to afford rent, send money back to their families, pay tuition, or devote enough time to their courses. Hunger can impact academic success in many ways, including loss of ability to focus, fatigue, and a weakened immune system and strained social networks. So food security on campus has become a hot topic for organizations trying to improve student wellbeing as well as for the administration, which is facing increasing pressure to provide more support to the Food Pantry and other support systems. Redfearn reiterated that “the UC Berkeley Food Pantry has been a huge resource in providing healthy free food for students, as well as CalFresh food stamps, nutrition resources provided by the Tang Center, and the Food Assistance Program for short-term meal point gifts. However,” she continues, “this issue is far from resolved and there remains extensive opportunity in both food recovery from the dining halls and long-term food assistance resources.” It is clear that although many organizations and committees on campus are working to address food insecurity at UC Berkeley, there is still plenty to be done. Studies published in UC Berkeley’s Spring 2016 Food Security Report noted the impact that a variety of social and economic identities have on food security, suggesting that a more wholistic approach may need to be taken to fully address this issue.

Bradi is a third-year student majoring in Public Health and Sociology. She is interested both in food system policy and women’s health advocacy, and hopes to earn her MPH and JD after finishing undergrad. In her free time, catch her bingewatching Netflix and downing her fourth cup of coffee. the

PUBLIC HEALTH ADVOCATE // 11

UNSEEN IN THE CITY

INDIA’S URBAN SLUMS by

KAMESWARI POTHARAJU contributing writer

ne billion. That is the number of people who are currently living in slum conditions. Yet, why is it that the majority of us living in the United States know so little about the lives and conditions of an eighth of our world population? Slum conditions, as defined by UN-HABITAT, entail the following: lack of basic services such as sanitation facilities and safe water sources, substandard housing (or inadequate building structures), overcrowding and high density, hazardous locations such as floodplains, insecure tenure, poverty and social exclusion, and a minimum settlement size in order to be recognized. While the list of characteristics is extensive, the takeaway is simple: one-eighth of the human population today lives in dismal conditions that are adverse to positive health outcomes. Moreover, at the current rate of urbanization, the population of urban slums is only destined to increase. Yet, urban slum health continues to be a poorly regarded area of public health because it has to do with an already neglected part of the population. Take India for an example. Urban healthcare was ignored despite years of rapid urbanization in the twentieth century simply because the Indian government tended to view the nation as a largely rural society, thus basing its conception of healthcare upon rural populations. However, India is one of the most rapidly urbanizing countries in the world, making urban slum health an increasingly important 12 \\ FALL 2017

problem for the Indian government to address. One of the most important issues with regards to health in urban slums in India is access to clean water, particularly for waste management. The lack of sewage facilities to process wastewater and provide avenues for safe treatment is a prominent reason for the spread of major infectious diseases like diarrheal conditions. Over the last decade, the government has undertaken various toilet building initiatives, mostly notably as a part of Prime Minister Modi’s “Clean India” campaign. While the World Bank loaned $1.5 billion to India to support the mission of ending open defecation and improving waste management, there continues to be a lack of access to such facilities both in rural and slum areas. For example, a community may accept a grant from the Indian government to build toilets but instead use the money elsewhere (or for a leader’s personal gain). In India, there is a vital distinction between “notified” (i.e. recognized) and unrecognized slums that largely correlate to the amount of government aid these communities receive, thus impacting the health outcomes of the slum residents. Residents of notified slums are entitled to not only land tenure — giving residents property rights to the land even if they do not own it — but also access to city services, most significantly connections to the water supply. However, nearly 60% of slum settlements throughout India are non-notified, meaning that they have less access to wastewater disposal and toilets. Even more importantly, these non-notified slums benefit significantly less from government

initiatives to improve slum health. This exclusion from the water supply results in slum residents illegally tapping into the water supply or paying exorbitant prices to have access to clean water. This lack of access causes widespread diarrheal diseases, which greatly decrease health outcomes in children. For example, in Kaula Bandar — a non-notified slum in Mumbai, the city with the largest slum population in the world — the child mortality rate is twice that of notified slums and 30% higher than non-slums, while the malnutrition rate is 10% higher than that of notified slums. The lack of clean water also results in epidemics of diseases like malaria, dengue, hepatitis, and leptospirosis. The effects of slum recognition can also be seen elsewhere in terms of health outcomes. For example, almost 80% of women living in notified slums give birth in hospitals, whereas only 65% do in non-notified slums. Similarly, approximately 80% of children in notified slums receive immunization against diphtheria, pertussis, and tetanus (DPT), whereas only about 70%in non-notified slums are fully immunized. Dr. Lee Riley, professor of epidemiology and infectious diseases at the UC Berkeley School of Public Health, has done research on slum health in Mumbai and Rio de Janeiro. When asked about the status of recognized slums in India, he said: “Whenever there is a recognition by the government of the existence of these communities, there is some improvement that can be made. The problem is, can that be sustained? These communities are getting larger and more people are living in these places.” As the populations of urban slums increase, it becomes increasingly challenging to both extend recognition to these newly formed settlements and provide adequate aid for such large populations. In India, the slum population is projected to increase to 104 million by the end of this year — 9% of the nation’s 1.28 billion people. It is unsurprising that the states with the largest slums continue to adhere to slum definitions that are outdated and narrow. For example, the state of Maharashtra, where Mumbai is located, created an addendum in 1995 to its 1971 Slum Areas Act that required cities to provide water and sanitation to slum residents that can prove their residency prior to January 1, 1995. However, since then, those who are unable to prove slum residency prior to 1995 or have moved to slums after 1995 are barred from accessing these government-allotted benefits. While the government could extend the “1995 rule” to a later date, thus expanding the definition of notified slums to include more citizens, it

is evident that officials recognize the monetary impact of this redefinition. Essentially, there is little to no incentive for the government to extend benefits to more slum residents. Not only are these people politically invisible — often illiterate and having almost no political influence — but they also pose a potentially increased burden on the government’s budgets and services. Although the health benefits of recognizing more slums are clear, the government lacks the motivation to take action. While NGOs are often considered as adequate alternate sources of aid, these organizations can only be effective when partnering with the government in terms of service delivery. For example, NGOs are not as accountable for their actions and their effect on the populations they serve as governments are; they are more inclined to provide smaller amounts of aid that are high in quantity but low in quality, whereas governments, under public scrutiny, are more likely to provide effective aid. Moreover, because NGOs tend to partner with governments, slum health will only become a priority for NGOs if it is a priority to the government. In essence, the move towards improvements in slums must come from the government first, and the change ought to start with improved legislation and political representation for these citizens. However, the question for us remains simple: why should we, the American public, care about this issue? Many of our large cities do not have obvious slum areas in the same sense as cities like Mumbai or Rio. Yet, Dr. Riley argues, it is essential for the U.S. public to have a deeper understanding of urban slum health: “It is probably the most important public health issue that will be coming up over the next ten to twenty years. If we don’t deal with the issue of informal settlements of the world, we will be in a huge crisis.”

Kameswari “Kamu” Potharaju is a first-year student from Fremont, CA, intending to major in Public Health and minor in Global Poverty and Practice. Her interests lie particularly in the fields of global health, health policy, and epidemiology, along with aspects of anthropology, sociology, and psychology that are relevant to public health. In the future, she would like to earn both a MD/MPH dual degree and pursue a career as a physician while conducting public health research. In her free time, she likes to try new restaurants, explore the city, and take naps. the

PUBLIC HEALTH ADVOCATE // 13

HUMAN TRAFFICKING

IN THE BAY AREA

ELISE RIO contributing writer

hen most of us think about sex trafficking we think about far away countries in Asia, Africa, or the Middle East. We think about sex and human trafficking as the responsibility of international aid agencies, and we rarely stop and think about trafficking in our own backyards. The truth is, human trafficking happens around the world. In a recent report published by the International Labor Organization (ILO), it was estimated that over 40 million victims were sold into modern slavery in 2016 alone, 100,000 of which were sexually exploited in the United States. Human trafficking happens throughout the country — and according to an article in The Mercury News, “because of California’s homeless and foster youth populations, immigrant

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communities, and industries that may be vulnerable to forced labor practices, California has the highest human trafficking rates in the nation.” Last year, according to a special task force commissioned by Mayor Ed Lee, 500 cases of human trafficking were reported in San Francisco, and Oakland was reported to have one of the highest rates of human trafficking in the country. Many organizations in the Bay Area have been working hard to figure out how sex trafficking begins, who is being targeted, and what can be done to stop this modern-day slavery and provide support for the victims. There are countless circumstances under which young people are sold into slavery each year. Some come from overseas and are promised good jobs in the United States. Once they arrive in large cities like Boston, New York, or

Oakland, they are sold into slavery and often forced to commit sexual acts for the profit of their bosses known as “pimps.” Shandra Woworuntu, whose story was featured in BBC’s Outlook podcast, was a financial analyst from Indonesia who was promised a job working in the hotel business in the United States. However, when Woworuntu arrived in the United States, she was not taken to Boston as she expected. Instead the taxi that picked her up at the airport took her and the women she was with to a house where she was drugged and forced to commit sexual acts against her will. Woworuntu was stuck in the trafficking business for years. She recounted that she was often drugged and was taken to hotels and brothels where she was repeatedly forced to commit sexual acts with strangers that often mistreated her. Woworuntu explained that she learned to be compliant and to remain quiet to avoid being beaten. She tried to escape several times but was often tricked by people who pretended to help her but then took her back into sexual slavery. Woworuntu’s case is an example of how immigrants can be taken advantage of and sold into slavery once they arrive in the United States. Many times, these immigrants struggle with English and do not know how to reach out and find people to help them. Woworuntu tried going to the Indonesian embassy when she finally escaped, but the embassy turned her away and refused to help. In other cases, as represented in the short documentary film Surviving International Boulevard, young girls who have histories of sexual abuses at home or are feeling abandoned by their community are seduced by pimps and lured into the business. Many of these young people, 70% of whom are women, are unaware of the dangers and become stuck in the cycle of slavery. The documentary is based in Oakland, California, and addresses how “poverty, hunger and other factors make children at risk for being coerced into sex trafficking.” Educators at Fremont High School explain the powerful lure of International Boulevard, a street that runs from Hayward to San Leandro and is

Once they arrive in large cities like Boston, New York, or Oakland, they are sold into slavery and often forced to commit sexual acts for the profit of their bosses known as “pimps.”

a major hub for U.S. youth trafficking. Sian Taylor Gowan, who directed and produced the film, said in an East Bay Times article that children in foster care, LGBTQ kids, and other vulnerable populations are most at risk. Legislators, educators, and nonprofits have been working hard to fight human trafficking in the Bay Area, the United States, and across the world. In Oakland, the Human Trafficking Prevention Education and Training Act, introduced as AB 1227 by Assemblyman Rob Bonta and sponsored by the California-based nonprofit 3Strands Global Foundation, has made California a national and global leader in the fight against human trafficking by requiring public schools to provide school-age kids with comprehensive human trafficking prevention education. The goal is to reach kids early and to be able to teach them how to recognize human trafficking techniques, avoid victimization, and find help. Human trafficking remains a huge problem in the United States and in the Bay Area, and it is important to educate the most vulnerable populations early to make them aware of the dangers trafficking poses to them and others in their community. Not only is prevention key, but the creation of rehabilitation programs for victims is also necessary. Trafficking victims can face psychological and physical trauma for years, which leaves a permanent mark and makes it difficult for victims to integrate back into society after they find freedom. Organizations like the U.S. Advisory Council on Human Trafficking, where Shandra Woworuntu now works, help to provide starting jobs for victims and connect them to psychological services.

Elise Rio is originally from Paris, France but grew up in Irvine, California. She is a sophomore majoring in Global Studies, Anthropology, and Molecular Environmental Biology with a minor in Global Public Health. She plans to go to medical school after Berkeley and get a Masters in Public Health. She loves to sail, travel, scuba dive, explore fun restaurants, and watch Tasty videos. the

PUBLIC HEALTH ADVOCATE // 15

Oakland’s Industrial Pollution by

USEF AWNALLAH contributing writer

he devastating North Bay wildfires in Santa Rosa, Sonoma, and Napa Counties have had immediate effects on the Bay Area’s air quality. For much of October, residents were advised to refrain from unnecessary outdoor exposure. Despite the recent spike in pollutants related to the fires, unhealthy air and the harmful health effects that come with it aren’t new to Oakland residents. Cassandra Martin, a community activist and worker at the West Oakland Environmental Indicators project, recalls her first experience with asthma among her three children when her oldest son was 6 months old. “He would crawl to the floor and he would lay there… She [her son’s babysitter] said he would get down there and his little chest would be going up and down up and down. I took him to the hospital three times in one day.” That night, her insistence on staying after the third visit saved her son’s life. No one in Martin’s family had asthma before, and all of her children were raised to lead active lifestyles, involved in music, a variety of sports, and all academically highachieving. Despite this, all of her children who have grown up in West Oakland suffer from the effects of poor air quality. “Every last one of them have asthma,” said Martin. Oakland’s abnormally high hospitalization rates and lower life expectancies aren’t new, and residents that live close to industrial and traffic-heavy areas are acutely aware of the air’s damaging effects. “This year and last year alone I lost about 25 of my family members,” said Martin. Martin is plain-spoken about the effect of West Oakland’s industrial pollution on those closest to her. Her outlook, however, is guided by the need for continued advocacy in West Oakland. “I’ve got to keep doing this. It’s for a good cause.” Her work with the WOEIP goes back to 2008, when she played a large role in surveying local streets for a Truck Traffic Study that revealed an underestimate in 16 \\ FALL 2017

previous measures of the Port of Oakland’s contribution to air pollution. Today, her work has grown in capacity and includes education and community-driven efforts to address poor air quality. Margaret Gordon, who founded WOEIP with Brian Beveridge in 2004, and currently is the co-director of the organization, refers to their relationship with the City of Oakland as “up and down.” Gordon served as the coChair of the Port of Oakland when she was appointed in 2007 by Oakland’s progressive mayor Ron Dellums. When asked about financial motivations, she was clear in affirming the role money plays in the city’s decisions. “Always. Always. Always. There is financial motivation behind anything with the city, because they’re always trying to recoup tax dollars. If the board feels as though it’s not in the business model for the port, they will not do it.” Further complicating the city’s role in addressing air pollution, the autonomous structure of the Port of Oakland makes it difficult to prompt change without federal or state intervention. Commenting on the city’s role in appointing board members, Gordon is also quite clear: “We have not had a real community engaged, progressive mayor since then [2007], about having local, impacted residents sit on that board.” In July of this year, a formal investigation was launched by the Department of Transportation and the EPA on discrimination against the community in their “neglect and systemic disregard” for the health of residents. While the findings have yet to be released, the long standing health problems confronted by Oakland residents are clear and persistent. What will it take to implement real solutions that address the health hazards facing Oakland residents? Usef is a junior transfer from Sacramento, California studying Political Economy. Outside of class, he enjoys biking around Berkeley and visiting the many outdoor destinations the Bay Area has to offer. After graduation, he intends to pursue a graduate degree and work in the fields of health advocacy and economic empowerment in developing countries.

NIGHTLIFE AND NATIONALITIES and the consequent “taboo” surrounding alcohol. A student moving from Switzerland explained how, in her family, “learning to drink responsibly is a basic oving to Cal is a significant adjustment for lesson in growing up.” Underage drinking may not pose everyone, whether they are from a town such a large public health threat in countries with lower 20 minutes away or a 20 hour flight away drinking ages as alcohol is not continuously denied and from Berkeley. Incoming students find young adults are not treated like children. After all, 18 themselves in a new world of possibility and responsibility, year old Americans can vote, marry, and serve in the with its own set of freedoms and limitations. Alongside military but they cannot buy an alcoholic drink in a bar a change of location comes a varying change of social or a restaurant. norms for transfer, in-state, out-of-state, Excessive alcohol use leads to increased and international students. Given the lack health risks including violent behaviour, of parental surveillance, it is not surprising disease, and forms of cancer. The “Drinking is so liver that underage drinking is a popular activity Substance Abuse and Mental Health Services in the social lives of young adults in the pressurized and Administration found 188,000 people under United States. stigmatized that 21 visited an emergency room for alcoholDrinking can form a large portion related injuries in 2011. Instead of focusing everyone seems of the social life and social norms for on banning alcohol, it is imperative that to be out of undergraduate students, including those universities use programs to inform students at Cal. One junior described drinking in about the risks of alcohol. For example, the control.” America as “so pressurized and stigmatized PartySafe@Cal team was created in 2015 to that everyone seems to be out of control.” A improve party culture and prevent multiple first year from Italy felt like he is “not taken seriously as hospital transports, injuries, public nuisance incidents an adult.” A number of international students described each weekend and occurrences of alcohol-related student the drinking scene in particular as “a complete culture deaths on our very own campus. shock”. Meanwhile, a student moving approximately Planning can make the difference between a great night twenty minutes away from home stated that “adjusting and a total disaster. It is life-changing to learn strategies to new social norms has been unexpectedly difficult.” on limiting negative consequences of excessive drinking. Because she lived so near, she did not expect so many As everyone — no matter who they are or where they changes including the way in which parties are thrown are from — is adjusting to some kind of change, it is best and social groups are formed. to minimize risks and maximize awareness for the best U.S. college students may not particularly drink or nights out. party more, but perhaps they tend to party in a more selfdestructive manner. According to the National Institute on Alcohol Abuse and Alcoholism, “about four out of five Priya is a first year student who has lived in eight countries college students drink alcohol and more than 90 percent and intends to study Public Health. In the future, she hopes to of this alcohol is consumed through binge drinking.” This work towards solutions for health, economic and socio-political can be attributed to the higher drinking age in America challenges in countries undergoing rapid urbanisation. by

PRIYA ROY contributing writer

the

PUBLIC HEALTH ADVOCATE // 17

More Money, More Problems by

HARSIMRAN BAJWA contributing writer

t 9 years old, I started having bad chest pains. I was very active, ate generally healthy, and never had any bad illnesses. However, in order to make sure I had no serious underlying health issues causing the pain, my mother took me to my primary care physician. My pediatrician told me and my mother that it was most likely just growing pains or some soreness from an elbow to the chest at soccer practice. But just in case, she suggested going to a cardiologist to get an electrocardiogram (ECG) to make sure I didn’t have a serious health problem. Two days later, we got a call from the cardiologist I had visited at Children’s Hospital Oakland. He told us nothing was wrong. My symptoms led him to think it was just costochondritis, or inflammation in my rib cage joints due to muscle exertion or light trauma. Stories like this represent a very common phenomenon in the U.S., that of medical overutilization. Too often, patients go through a wide array of tests, procedures, and treatments that provide little to no value in increasing health but contribute to a huge waste of money. The national average cost of an ECG is $183, and that doesn’t 18 \\ FALL 2017

include the cost of seeing the cardiologist. In Dr. Atul Gawande’s New Yorker article “Overkill,” Gawande states that in 2010 alone, waste accounted for 30% of all health care spending, approximately $750 billion. Gawande also states that “virtually every family in the country has been subject to overtesting/overtreatment in one form or another.” In fact, every year, 25–42% of Medicare patients receive at least one of the 26 tests or treatments that medical researchers consider useless. Besides high health costs, medical overutilization also increases the chance of developing more health problems. No treatment, be it a test a drug or a procedure, is without any risk. From complications after surgery, to dangerous interactions between prescription drugs, useless treatments provide no health gains but still carry the risk of negative side effects. In “Overkill,” Gawande points out that the U.S. is doing so many radiation imaging tests that it’s believed to be influencing the population’s increasing cancer rates. So, why is medical overutilization so rampant if we know it only increases costs and puts patients’ health at risk? The answer lies in a combination of many

different factors: patient expectations, doctors’ fear of misdiagnosis, financial incentives, and doctors’ fear of litigation. In an interview with Patricia Timm, a registered nurse with Sutter Health in Northern California, she states that “on average, most patients we see in the Bay Area are pretty well informed either through their own life experiences, prior care and prior medical research. Most patients are not timid when requesting Too often, and in some cases demanding patients go what they want with respect through a wide to their case.” In situations like array of tests, the ones she describes, patients, especially well-educated ones, procedures, have a certain level of expectation and treatments of service when it comes to their health and prefer more care to that provide less care, even if the extra services little to no value they receive are of low-value. in increasing In an interview with Dr. Ravinder Sohi, a primary care health but physician and lecturer at the contribute to a University of Toronto Faculty huge waste of of Medicine, she states that even doctors sometimes prefer more money. care to less when they are not completely sure of the diagnosis or what the best procedure to take is. Many medical professionals fear missing critical medical information regarding a patient by not doing tests or choosing to forgo a procedure because they’re afraid that one missed test might be the reason a patient’s health suffers severely down the road. Another factor that contributes to the utilization of low-value care is the way in which we pay medical providers. Many doctors are paid through a fee-forservice payment method, meaning they get paid for each service they provide to a patient, regardless of the quality of care they’v eprovided. With this payment method, there is no financial incentive to provide less care for patients; in fact, there is a strong financial incentive to offer patients more tests and procedures because the doctor is compensated for everything they do. Lastly, the U.S. is known for being one of the most litigious societies in the world. Fear of litigation concerns many professionals, including doctors. As Dr. Sohi explains, fear of being sued is just another incentive for doctors to look towards doing more (even if it’s just more low-value care) rather than doing less. Patricia Timm

also happens to be a medical malpractice attorney and she notes that almost all of the cases she works on involve patients who sue for damages after they believe they did not receive an adequate amount of care. Because of this, many doctors practice defensive medicine: the act of recommending a test or treatment that is not necessarily the best option for the patient, but an option that protects the physician from being sued. As healthcare costs continue to increase, insurance plans and the federal and state governments continue to look for ways to decrease the amount of medical waste that exists in our healthcare system. Dr. Ravinder Sohi explains that even despite the very obvious ways that Canada’s healthcare system differs from the system here in the States, they utilize methods and campaigns that we could learn from. She first argues that primary care physicians need to become more educated about the risks that exist in referring patients to specialists. Specialists’ appointments tend to be much more expensive than visits to primary care physicians and tests and procedures done through a specialist are also extremely pricey. She also states that the “Choosing Wisely” national medical campaign in Canada has worked very well in bridging the gap between medical providers and patients regarding overutilization discourse. In the U.S., progress is being made in disincentivizing doctors from over-treating; many healthcare organizations are implementing payment methods in which doctors are paid in terms of the quality of care they provide, rather than the quantity. Another important point to recognize is that while 30% of all medical care is often waste, there is a large population, even within the U.S., that exists that still doesn’t receive basic preventative care. Tests, treatments, and medical procedures are extremely important in finding diseases and illnesses and then curing them. Instead of having part of the population overutilize the system while another part has no access to it, the waste must be cut and resources shared with those who currently have none. As Dr. Atul Gawande concludes at the end of his article, “It isn’t enough to eliminate unnecessary care. It has to be replaced with necessary care.”

Harsimran is a third year pre-med Public Health major. After graduating from Berkeley, she hopes to pursue an MD/MPH and serve the North Bay community. Harsimran’s hobbies include going to the movies, traveling, and hiking. the

PUBLIC HEALTH ADVOCATE // 19

to dream or not to dream? dreams and your health most dreaming occurs in REM sleep, a lack of dreams implies a lack of REM sleep. Lack of REM sleep can also result in increasing one’s risk of obesity, depression, reams have been spoken of and studied for sensitivity to pain, dementia, and Alzheimer’s disease. centuries. The relevance and value of dreams There has been recent information that indicates that is not clearly understood. Many claim that they “dream loss” is spreading, and this coincides with the do not dream. Though dreams may seem to be an added spread of depression in America. Are you dreaming bonus to one’s sleep, unless he or she has a nightmare, often? What are you dreaming of? they actually have substantial value and indicative measures. Dreams indicate an individual’s quality of sleep Dream Symbols Analyzed and health status. Dream symbols, when analyzed, give Dr. Meyers, a medical doctor who teaches at Cornell insight into memories, worries, and subconscious topics. University Medical Center, mentions that Sigmund Though abstract and sometimes surreal, we do have Freud had first discussed the “naked in public” dream in some control over our dreams. 1900. However, many others analyzed this dream as well. Erich Fromm, a German psychologist, suggested being To Dream or Not to Dream naked in one’s dream would be a representation of one’s Evidence shows that dreaming, or being in REM natural self. Feeling embarrassed of this would imply that sleep, can affect function, memory, mood, and other the dreamer is uncomfortable with their fundamental key social factors that dominate our lives. Therefore, self. These dreams of being naked are rooted in feelings entering the REM phase has clear health implications. of guilt and inferiority. In most situations, no one pays Individuals who drink alcohol or use cannabis before attention to the naked dreamer. Despite this, the dreamer sleeping “significantly [disrupt their] REM/dreaming” feels embarrassed, ashamed, and exposed. A traumatic as stated by Dr. Ruben Naiman from the University of attack to one’s self esteem would result in this dream. Arizona Center for Integrative Medicine. In addition, This significant lowering of self esteem is subtle at times. sleep medication and antidepressants have been found Some real-life scenarios that may cause this dream are to negatively affect REM sleep. Cycling through REM feeling neglected by someone the dreamer cares for, or improves concentration, memory, and energy level. Since being disrespected publicly or privately. by

CHIGOZIE MADUCHUKWU contributing writer

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Insect dreams are harder to force. Physical health, mental health, categorize and analyze. One study social interactions, academic work, at Everett Community personality flaws, College on the and many other connection between Dream loss is an factors may make dreams and insects one feel vulnerable epidemic. This is and used. describes how different cultures have different not normal, nor views towards insects. How to Dream is it a healthy For instance, certain Tracking your occurrence. Spread cultures emulate the sleep quality is one web of a spider as a of many indicators the word: Those dream catcher as an silly, nonsensical of your health attempt to catch bad level. Dr. Naiman dreams. In American dreams do matter. explains that if you culture, most insects drink alcohol or use are viewed in a cannabis, do it well negative light. Many bugs terrify before going to sleep so that you Americans; thus insects in dreams can optimize your REM or dream are oftentimes related to feelings states. Search or ask a healthcare of dread. Each insect has its own professional for alternatives to sleep cultural symbol. Roaches in America, medications — ones that will not for example, are often signs of a hinder the REM cycles. You also dirty location. Spiders are thought increase your chances of dreaming of as being poisonous and trapping. by getting a healthy amount of sleep. Moths and mosquitoes are seen as To improve the quality of your sleep, annoyances and hard to kill; thus they try avoiding technology use before cause anxiety when spotted. When going to bed. Want more dreams? dreaming of spiders specifically, we Sharing your dreams with others can personify their ability to weave can improve the amount you dream webs and catch prey as manipulation. because you are increasing your The spider, according to the book personal attachment to remembering Nightmares: How to Make Sense of Your your dreams. Dream loss is an Darkest Dreams by Alex Lukeman, is epidemic. This is not a normal, nor an “ensnaring and controlling force.” is it a healthy occurrence. Spread This suggests the dreamer feels the word: Those silly, nonsensical controlled or manipulated by some dreams do matter.

the

Dream Big Dreams can open doors to deeper concepts that our minds construct. Something that’s been on the mind for a while, or something that is thought about thoroughly, can be represented in a dream. Though sometimes literal and explicit, dreams can also be indirect and confusing. It is easy to ignore these dreams and think our minds are having pointless fun. Try to think about the dreams you have. When you awaken, write down what you remember and then ponder over it. This opens up an opportunity to reflect on your current mental state and health. College students tend to not prioritize sleep or dreams. However, sacrificing sleep may lead to depression, early memory loss, or physical barriers. Sleeping — and dreaming — will be better for a grade than a dreamless, sleepless allnighter.

Chigozie is a first-year student from Sacramento, California, intending to major in Public Health and minor in Chemistry. He plans to use his knowledge in Public Health and then get his Master’s in Nursing. He loves to walk dogs, work with his mom and her mentally disabled patients, and learn about human physiology.

PUBLIC HEALTH ADVOCATE // 21

housing the

homeless

AMANDA REILLY and NATALIA GARBAN contributing writers

hile the lack of a home is at the root of the term “homelessness,” other needs of the homeless are often addressed before housing. Food and clothing are needed to support the homeless, but in order for populations who are facing homelessness on the streets to transition to better living accommodations, affordable housing must be made available. According to Maslow’s hierarchy of needs, housing is a basic physiological need that he deemed as important as food and water itself. Nevertheless, permanent shelter is often the most difficult need to provide. In 2010, the United States endorsed a “Housing First” approach to chronic homelessness which focused on working towards providing permanent supportive housing without prerequisites such as substance abuse recovery. The lack of a stable permanent home has caused a cascade of other issues for the homeless community, such as poor health and inability to apply for jobs. Several studies have shown the effectiveness of Housing First approaches, including a 2013 study published in the American Journal of Public Health that found 77 percent of participants involved in Housing First lived in their housing for at least two years. Homelessness is a vicious cycle that requires intervention at many different points. 22 \\ FALL 2017

However, focusing on housing may be able to improve many aspects of life for these people. Although the Housing First approach may sound like an appealing solution, there is still a lot of work to be done for homeless and low-income housing. Many low income housing developers have multiple requirements for residents and do not have the resources to provide the services that may allow people to meet the qualifications needed for applying. According to the National LowIncome Housing Coalition, a Republican representative proposed a bill in 2015 that would require federally funded programs to refuse housing to applicants who fail a drug test or are deemed to be at a high risk for drug abuse. This bill, which has yet to be voted on, would create another barrier for those seeking to get into the programs they need to improve their quality of life and eventually enter the workforce. Even though Berkeley has homeless shelters and some transitional housing options, not all these programs offer permanent supportive housing. In 2015, the City Council Report estimated a homeless population of 1,200 in Berkeley. This same report also includes an inventory of the homeless services and housing offered in the city. There are 195 case management slots for permanent housing, provided by seven organizations. The Berkeley

Food and Housing Project currently houses 21 chronically homeless men and women living with mental illnesses, and provides them with the daily services and care they need. Permanent shelters are often deemed as the least feasible resource to provide to homeless communities because of the high cost and lack of availability. However, cities are beginning to increase research efforts to determine the cost of homelessness per capita compared to the cost of providing housing per capita. So far, cities like Los Angeles and states like Utah have discovered that housing an individual and keeping them housed is less costly than keeping them on the streets. Sam Tsemberis, who is the founder and CEO of Pathways to Housing, a foundation based in Los Angeles and proponent of the Housing First initiative, supports these results in a short documentary that is part of the “Now What” series by Huffington Post. “Putting someone into an apartment is actually cheaper than keeping them homeless,” says Tsemberis. The cost of an individual going in and out of institutions such as rehabilitation centers, prison, transitional housing, hospitals, and overnight shelters is higher than the cost of rent for an apartment for that individual. Research led by Lloyd Pendleton, former director of the Utah Homeless Task Force, has determined that on average, a person facing chronic homelessness costs the state more than $20,000 per year. In comparison, providing housing for an individual only costs the state around $12,000 on average per year. Even if governments fail to realize that housing should be prioritized because it is a basic human need, they should view the housing crisis as a financial priority. Investing in housing now means investing less in homelessness later. It translates into a more cost effective, permanent, long term solution to homelessness, leading to healthier lives and lower hospital bills. On a smaller scale, communities can make significant strides towards helping their homeless populations, but government policy is also essential to engendering nationwide improvement. The appointment of Ben Carson to

the Department of Housing and Urban Development has raised many questions and concerns. While Carson is a renowned neurosurgeon, he has no expertise in housing and development policy. Lack of knowledge of the issues at hand is problematic when managing an annual budget of nearly $50 billion and making decisions regarding programs that pertain to housing, education, transportation and community redevelopment. There is no simple fix for addressing homelessness and housing, especially given that people who are homeless — such as people living in their cars or moving between friends’ houses — may not always be visible. Increasing access and availability of resources such as supportive permanent housing to homeless people will be essential to reducing homeless populations and improving the quality of life of people affected by homelessness. As individual communities seek to address homelessness, dynamic and knowledgeable leaders are needed to continue to advocate for and implement effective housing approaches.

Amanda is second-year intended Public Health major and loves the interdisciplinary nature of public health. In addition to being a writer for The Public Health Advocate, she is the chair of the International Health Committee for Cal UPHC and a HSI TA. Outside of school, she enjoys anything outdoorsy including backpacking, skiing, and scuba diving. Natalia is a second-year intended Public Health major or Nutritional Science/Toxicology major. Alongside her role as a print and online writer for PHA, she is a caseworker at Suitcase Clinic, a TA for the Health Service Internship, and an Orphan Drug Research Assistant at the California Department of Public Health. Natalia has always been passionate about maternal and child health care and has recently become very interested in the role of housing and urban development in public health, she hopes to get her MD and MPH and work for an NGO that provides housing first and prenatal care to expecting mothers. the

PUBLIC HEALTH ADVOCATE // 23

DEALING WITH DISABILITY by

ALISHA MEHDI contributing writer

isability is defined as “a physical or mental condition that limits a person’s movements, senses, or activities.” According to the National Center for Education Statistics, approximately 11% of the 2.56 million undergraduate population identified as having a disability in the 2011-2012 school year. This equates to more than 280,000 students. These are hundreds of thousands of students who do not have the same luxuries as most of us. These students are living with life-altering circumstances that can have an impact on their performance in school, regardless of their dedication and commitment to their education. It’s easy to take ordinary tasks such as walking, running, hearing, participating, and even writing with a pencil for granted, but for others with disabilities, these simple things are an everyday challenge. However, the point of recognizing these differences is not to promote ostracization of our peers but rather to raise awareness and create a safe environment on campus where all people feel welcomed and represented. In the fall of 2013, UC Berkeley reported that over 1,200 students, 3% of faculty, and 6% of staff identified as disabled. These are individuals you see every day in your classes, on campus, and at school events. UC Berkeley Cal Answers published surveys in 2016 that portrayed how disabled undergraduate students with disabilities were represented on campus “at far lower levels (often less than half) than they are across the state.” As opposed to the 10% of disabled people in the California population, 24 \\ FALL 2017

only 6% of undergraduates at UC Berkeley identified as disabled in 2015. Students with diagnosed disabilities or disorders are often underrepresented in our student body, partly due to the ignorance of others in their community. It shouldn’t come as a surprise that a person who doesn’t have personal interactions and relationships with those living with disabilities would have limited knowledge about the challenges these individuals go through on a daily basis. People with disabilities constantly have to face a number of attitudinal barriers including stereotypes, pity, denial, fear and simply being misunderstood. The National Society for Mentally Handicapped Children, an organization in the United Kingdom, found that 73% of people were not able to provide a correct example of a learning disability when asked in a survey taken in 2008. This lack of knowledge and understanding of different types of disabilities can make it harder for the general population to sympathize with these individuals. Below: UC Berkeley’s Disabled Students Program serves as a resource for students with any form of mental or physical disability or disorder.

The disabilities in and of themselves are not always the hardest challenge. Negative stigmas and attitudinal barriers surrounding disabilities can inflict even greater harm. Many students with disabilities have the passion and motivation to learn and gain higher education but sometimes the lack of resources and accessibility can hinder their goals. Nils Skudra, a 2016 UC Berkeley alumus, graduated with a 4.0 GPA, a B.A. in History, and a minor in Theatre/Performing Arts. At just 10 years old, Nils was diagnosed with Asperger’s Syndrome. Nils and his family had disheartening experiences with the resources made available to them on campus due to the limited levels of social support. They believe a widely The disabilities held sensitivity in and of training class themselves should be are not always implemented that educates students the hardest about the challenge. difficulties facing students with many different types of disabilities. This would encourage students to foster a sense of thoughtfulness and sensitivity regarding the topic. This includes an emphasis on empathy and some basic background knowledge of common disabilities and disorders. These steps can help lead to a more inclusive environment and a stronger campus community. Marginalization of individuals who might be different is insensitive and harmful to those affected. There are steps we can take to be more welcoming, which includes talking to students who you might not normally talk to or making sure other peers are not excluded from conversations. Nils recalled several

Above: A comparison between a neurotypical brain (left) and an Asperger’s brain (right). The neurotypical brain has a stronger ability to process what is heard while the Asperger’s brain has a stronger ability to process what is seen.

occasions where he attended social events on campus only to find himself ostracized because of his disability. Students on campus should think of clubs, organizations, and their peers as a supportive network. According to the Iranian Red Crescent Medical Journal, in a study conducted in 2013 — specifically for people with physical disabilities — social support can help convalesce psychological states of those living with disabilities. Regardless of health benefits, making an effort to be inclusive should be a portrayal of empathy and compassion. The Disabled Students Program on campus serves as a resource for students with any form of mental or physical disability or disorder. However, UC Berkeley’s effort to become more accessible and inclusive towards those living with disabilities can be improved. Karen Nielson, Director of the Disabled Students Program, admits that there is work to be done to improve the DSP office’s quality of care provided to its students. Nielson and the DSP staff are taking several measures to help develop a more supportive environment at the DSP. Their offices have already begun to roll out initiatives that include a social skills group that meets weekly to provide support for students on the autistic spectrum. They also plan the

to have a space on campus for all disabled students which can serve as a common area, where they can interact with other DSP students, counselors, and mentors. They are also currently hiring experienced disability specialists who will undergo a year-long training where they will be required to learn more about disability law, documentation, and various accommodations available for those with disabilities. The DSP program is steadily changing to implement new ways and programs to create a more accessible and welcoming environment for disabled students at UC Berkeley. Next time you walk to class, imagine how the situation would be different if you were in a wheelchair or imagine how hard note-taking would be for a student with serious hearing loss. As members of the UC Berkeley community, we have a responsibility to use our privilege to promote a more inclusive environment that is accommodating and accepting of everyone. Alisha Mehdi is a current junior interested in public health, public policy, and demography. Within public health, Alisha is specifically interested in the field of biostatistics and epidemiology. In the future, Alisha also wants to study genetic disorders and the spread of infectious diseases. PUBLIC HEALTH ADVOCATE // 25

silent contaminant by

JESSICA GARCIA contributing writer

he medicine cabinet is a routine pit-stop for many individuals during the flu or cold season. As students scurry to feel better in time for numerous exams, it is important to take a second look into the depths of those cabinets once in awhile to confirm that medications or pharmaceuticals have not passed the expiration date. While people are used to checking expiration dates on food labels, labels on medicines often go unnoticed. This can be dangerous because unlike the potentially mild consequences of eating slightly soured food, the active ingredients in medicines may be reactive and actually cause harm to one’s health. Once an individual has found expired medications, the next question that comes to mind is where to dispose of them. There are many ways to dispose of medications, but three common disposal practices are flushing them down the toilet, washing them down the sink, or discarding them as household trash). The first two options pose issues because both actions introduce many pharmaceuticals into the wastewater system, and the last option could accidentally poison pets or trash scavengers. Practicing safe disposal practices for expired medication is important here in the Bay Area since much of the population lives near a large water source.This means there is high risk of introducing pollutants to the environment. According to an article published by the University Health Services last year, Government studies have revealed that 80% of U.S. waterways have considerable concentrations of prescription drugs and other pharmaceuticals . The problem lies in the fact that wastewater treatment plants cannot effectively remove these toxins, and thus humans and wildlife will be exposed to the chemical-filled effluent. As a result, prescription medicines disposed down drains are showing up in 26 \\ FALL 2017

streams and rivers in the San Francisco Bay, and one would expect these levels to rise as medication usage continues to increase. Community-based methods for minimizing the amounts of pharmaceuticals in the Bay Area water system include the Take-Back programs that have popped up in many places around California. UC Berkeley’s TakeBack Program, established in 2016, is operated by the Environmental Services Division of the East Bay Municipal Utility District. They are able to collect expired and unwanted medications from residential customers in the wastewater treatment service areas. This program has successfully collected over 24,000 pounds of medications according to the University Health Services article. Kim Jarboe Lapean, the Tang Center’s media representative, speaks highly about the effectiveness of the program, mentioning that the Tang Center is also taking expired medications and is accessible to students and the general public. The green disposal bin for pharmaceuticals is located in the Tang Center Pharmacy, and it is as simple as dropping off a sealed plastic bag with the pharmaceuticals inside. However, the disposal container does not accept needles, vitamins, or controlled substances. Ultimately, it’s to the benefit of the environment and the Berkeley community that students stay informed and connected to resources regarding the safe disposal of unwanted or expired pharmaceuticals. Jessica Garcia is a senior majoring in Molecular Environmental Biology. Her interests include field research, specifically within the area of natural aquatic habitats. She is currently doing research with an entomology laboratory on campus to understand the distribution of aquatic insects. After graduating, she is interested in conducting more research about aquatic habitats in third world countries, where pollution of these regions is prevalent and there are major public health implications.

CARBON EMISSIONS IN SOUTHEAST ASIA by

JORDAN KEEN contributing writer

he Earth’s climate has developed since the beginning of time. Seven thousand years ago, the end of an ice age marked the beginning of the modern climate era — and of human civilization. The scientific evidence for climate change has always been there. As per NASA, “warming is more than 95% probable to be the result of human activity.” This human effect has been accumulating since the mid-20th century and proceeding at a rate that is unprecedented. As per NASA, some scientists expect a warmer world to bring changes in “disease vectors”—the mechanisms that spread some diseases. Insects previously stopped by cold winters are already moving to higher latitudes (toward the poles). Warmer oceans and other surface waters may also mean severe cholera outbreaks and harmful bacteria in certain types of seafood. Specifically in regions like India, limited resources can bring about many health consequences, including cholera, malaria, and dengue, all of which are vector and waterborne diseases. Cholera, a fecal-oral transmitted disease, can be highly prevalent in areas with high water flow, especially after monsoons and floods. In addition to these kinds of diseases, the Indian Journal of Medical Research predicts “an increased frequency of floods due to greater intensity of rainfall events and to glacier lake outburst floods (GLOFs) in mountainous regions.”Melted ice drawn from places like Antarctica and mountain glaciers in tropical areas show that the Earth’s climate responds to changes in

greenhouse gas levels. Extreme heat, natural disasters, poor air quality, allergens, can all affect human health, and are all consequences of global warming. According to NASA, sunlight, warm air, and the pollution stemming from power plants burning coal and cars burning gasoline combine to produce groundlevel ozone (smog) which humans experience as poor air quality. If sunlight, fossil fuel pollution, and air currents remain the same, the resulting rise in air temperatures will continue to increase smog levels,. More carbon dioxide helps plants to grow faster, mature earlier, but also produce more potent allergens. These allergens contribute to the most common chronic illness in the world: allergies. The symptoms of allergies can prove to be a mild but sometimes serious health threat, affecting the wellbeing of millions of people across the globe. Thus, carbon emissions and the overall heating of our planet ultimately puts human health at a greater risk of health complications. Deaths mounting from infectious diseases, air quality, and allergens can can be detrimental to the future of our health. Jordan is a second-year student interested in public health and public policy. He is particularly interested in working in epidemiology or with policy-related issues regarding homelessness, safety, energy, housing, and environmental health. He hopes to either work for the city as an epidemiologist or as a policy decision-maker. In his free time, Jordan watches his favorite sports team from LA, plays video games, and eats mangoes. the

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INNOVATIVE POLICIES IN ACTION:

How a city’s health department addresses racial inequality

NICK MURDOCK contributing writer

his past September, elementary and middle school administrators from across an urban city met to talk about a problem that had since gone unnoticed: their suspension rates. More specifically, who was being suspended. Some schools had nearly three suspensions per child enrolled, others suspended black students almost twice as much as white students. And most importantly of all — this meeting of great minds wasn’t dreamt up by a superintendent, but Below: Data collected by the Kansas City, Missouri Health Department show that racial disparities in suspension rates still widely exist in the city’s school system.

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rather by the city’s health department. Municipal health departments have long been considered the heart of some of the most straightforward works of public health. Performing disease surveillance, restaurant inspections, and vaccinations for children, the health departments often follow a somewhat universal job description whether they are in a major metropolis or a smaller county government. But recently, that’s begun to change. Some cities are taking on a much more progressive role, one that requires a lot more work, but arguably will have a greater impact on public health than any restaurant inspection or even vaccination campaign ever could. The future of public health appears to be in addressing

the social factors that affect the health of America’s communities. More and more experts are realizing that systemic inequalities are some of the biggest barriers to improving a city’s health. Those systemic inequalities are exacerbated in a place like Kansas City, Missouri. The Midwestern town noted for its hospitality and barbecue (and World Series-winning baseball team) is deceivingly large — home to over 430,000 residents. And it’s also the seat of over a century’s worth of forced segregation. When the city was expanding in the mid-20th Century, renowned city planner J.C. Nichols fought hard to ensure racial segregation remained the norm. Via neighborhood association contracts that forbade persons of color from moving into neighborhoods on the white side of town and by drawing an arbitrary line in the sand — Troost Avenue — Nichols created a system of racial segregation that has been extremely difficult to mend in the decades since. With Troost selected as the border between lands considered “white” and those considered “black,” inequalities began to grow in all aspects of city life. Not the least of which was health. Even today people living in zip codes east of Troost (planned by Nichols as the side for African-Americans) have an average life expectancy years below those of residents living west of the Troost dividing line. That’s just one reason why the city’s Health Department felt they needed to intervene. In 2016, Kansas City created a new division within the Health Department: the division of Community Engagement, Policy, and Accountability, or CEPA. The CEPA team was headed by Dr. Sarah Martin, PhD, MPP, MPH, a U.C. Berkeley Goldman School of Public Policy and School of Public Health alumna. The CEPA team’s mission was to address inherent policy barriers that reinforce inequalities and negatively affect citizens’ health. Dr. Martin said that the role of those working in the field of public health is to be a “convener.” “We need to sound the alarm—and more and more health departments are making a name for themselves as innovators in social policy. It doesn’t take anything complicated …. What you need are friends and allies throughout the city and across sectors.” Under the direction of Dr. Rex Archer, M.D., the city began to take a much more proactive approach to addressing health inequity. For example, they started partnering with community organizing groups, such as those that work with local church congregations to mobilize voters and activists within the community. One such groups was Communities Creating Opportunity

(CCO). Kansas City worked so closely with CCO that the Health Department entered into a formal agreement with them and moved their offices into the Health Department’s building which happens to sit at 24th Street and Troost Avenue, right on Nichols’ “border.” This cooperation appears to be the direction Above: Dr. Sarah Martin, PhD, MPP, MPH, UC Berkeley SPH and Goldman that many forward- School of Public Policy alumna and thinking public current Deputy Director of the Kansas health departments City, Missouri Health Department. are moving towards. This decision was so monumental that the Kansas City, Missouri Health Department was awarded the 2016 Local Health Department of the Year award by the National Association of City and County Health Officials, one of the highest honors a municipal health department can earn. Employees of the Kansas City, Missouri Health Department want their framework for addressing the social determinants of health to spread far and wide. According to Dr. Martin, “It just takes one person. Figure out what your department has to offer other departments and elected officials and market that aggressively. Anticipate the needs of your policymakers and be ready to react to emerging policy windows.” These key policy windows offer a means to address centurieslong causes of public health disparities. As for the education summit, many are hoping this was just the first of many partnerships with community organizations to increase third-grade reading levels, one of the biggest predictors of high school graduation rates which in turn are predictive of people’s health over the course of their lifetime. Luckily, Kansas City now has a progressive policy-oriented health department that can facilitate such conversations well into the future.

Nick is a second-year intended public health major, with a keen interest in health policy and addressing social determinants of health in urban environments. He’s a great cook and hopes to get an MPH and work as a public health statistician or in public health policy. the

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memory and music does music hinder learning? by

SHAINA DESAI contributing writer

usic has always functioned as a social staple in society. It brings people together and is present in almost every aspect of life. Even while studying and completing homework assignments, many students put in headphones to listen to music. However, this practice is so engraved in our society that many students are unaware of this exercise’s distracting effects, exposed by the significant research going on in this field. Music cannot have an entirely positive or negative effect on a person, as there are too many factors involved, both individually and in the type of music itself. Music is technically under the umbrella of auditory learning, but is processed in other areas of the brain than just the language center. Because of this almost-complete involvement of the brain, new research, like those by the American Music Therapy Association, suggests that music therapy has the potential to benefit students with neurological disabilities. Though seemingly separate entities, music and memory are extremely interconnected due to music’s ability to revolutionize the brain; tone, pitch, and rhythm are all aspects of music, which elicit bodily responses and release neurotransmitters, enhancing memory. Music efficiently aids with memory recall primarily because there is no true music center in the human brain.

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Depending on the music, it has the capability to activate several parts of the brain, which utilize different methods to memorize information. In Daniel Levitin’s This Is Your Brain on Music: the Science of a Human Obsession, he describes, “The story of your brain on music is the story of an exquisite orchestration of brain regions, involving both the oldest and newest parts of the human brain.” The frontal lobe, responsible for problem solving, and the temporal lobe, the center of auditory perception, are the first parts of the brain that initially decipher music at the first auditory stimulus. While these two lobes of the cerebrum are working vigorously, several other brain cells begin deciphering components of music, such as rhythm, pitch, and melody. Many scientists believe that the right brain is the creative hemisphere of the human brain, but there is controversy over the subject because it is nearly impossible to pinpoint a single side, segment, or region of the brain where music is processed. There seems to be no central music processing location because music influences so many other physical and emotional parts of the body, and there is so much variation within music itself. If a song includes lyrics, Broca and Wernicke’s areas, the areas of the brain which process language, will also become involved to translate and analyze the lyrics. If a song has emotional significance to the listener, episodic memory will kick in and teleport the listener to the time and place of importance. Since music significant to a person has the power to force them to associate the music with a previous event or experience, music thus

also has the capability to reach the depths of the human relevant in broader terms. The connection between mind by recalling information stored in one’s long-term emotion and music could be the key to helping people with memory. specific neurological disorders. Research has boomed Typically, classical music is thought to augment in the field of music therapy, which is is advantageous memory retention due to its legato style, specific for students with disabilities, such as ADHD, autism, rhythmic patterns, and lack of lyrics. For and Alzheimer’s. According to the Music example, scientific writer and musician Therapy Association of Ontario, music Laurence O’Donnell states that “baroque Though seemingly therapy is “the skillful use of music and music, with a 60 beats per minute beat musical elements by an accredited music pattern, [activates] the left and right separate entities, therapist to promote, maintain, and brain, ... maximiz[ing] learning and music and memory restore mental, emotional, and spiritual retention of information” and providing health.” There is no single effective type or are extremely myriad sources of recall. Thus, many genre of music because of its individualized interconnected modern study playlists are based on this nature. Music therapists ensure to select lyricless style and include slow, somewhat music tailored toward the individual’s due to music’s complicated, harmonious chords. preferences, emotions, and previous ability to To test the effects of music on memory, experiences in order to elicit recall and revolutionize the I conducted a survey. Of 51 UC Berkeley concentration. students, 47 stated they regularly listen to Music and memory prove to be an brain ... music while doing homework, with only six important link for so many people. students stating they utilize instrumental Although some music can hinder learning, music. Of the 41 remaining that listen to music but do not it is starting to become revolutionary for people with listen to study music playlists, 29 students stated that the neurological disorders. As more research is conducted, music they listened to could sometimes be a distraction. there’s the possibility that instead of prescribing This is significant because it indicates that some students medication, music could be the remedial solution to are aware of the effects of lyric-filled music on learning, some widespread medical problems society faces today. but still choose to listen to music while doing important tasks. One possible explanation as to why students listen to music despite being aware of these adverse effects is Shaina is a sophomore intending to major in Public Health that their environment may be more distracting than and minor in Data Science and serves as a contributing writer, the music itself, so the issue may be larger than sheer copy editor, and layout editor. She hopes to further study obliviousness. epidemiology and biostatistcs to conduct and analyze research The connection between music and memory is also in healthcare fields.

the

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“I DON’T SPEAK ENGLISH” LANGUAGE BARRIERS IN HEALTHCARE by

VIVIAN HONG contributing writer

hat is health literacy? As defined by the American Nurse Association, health literacy is “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions”. However, language barriers are becoming an increasingly bigger issue as more and more Americans speak languages other than English. The 2013 American Community Survey reveals that “a record of 61.8 million U.S. residents (native-born, legal immigrants, and illegal immigrants) spoke a language other than English at home”, and this number continues to increase. As the number of minority immigrants increase, many have to rely on interpretation services to receive proper access to health care. However, translational services may not always be readily available as interpreters may be scarce and translation services may be costly to providers. As a result, doctors often resort to ad hoc interpreters, or staff members, family members, or friends who are somewhat proficient in the language. Misinterpretation then becomes a common issue. As program manager of the Berkeley chapter of a national health care organization called Health Leads, Fabiola Gutierrez describes a common problem she often encounters at the Health Leads desk in West County Health Center. She states, “There tends to be a lower number of translators for languages that are further underrepresented. Last week, an advocate tried to help the client apply for one of the community programs and they were looking for Hmong translator. They called translation services for ten minutes and even tried calling some community partners, but they didn’t have translators available for the language. And when clients cannot access an interpreter, they are more afraid to apply or access different resources.” This barrier in communication may also result in the 32 \\ FALL 2017

lack of trust, weaker interpersonal relationships, lower patient satisfaction developed between the patients and healthcare professionals, and further health disparities among marginalized populations and socioeconomically disadvantaged groups. Studies from the New England Journal of Medicine show that patients with language barriers tend to have higher rates of hospitalization, lower rates of follow-up after emergency situations, lower rates of medical adherence, and reduced rates in use of preventative services. Research conducted by the American Nurses Association illustrates that patients can definitely benefit if nurses and interpreters were “cross-trained in cultural competence and health literacy in addition to medical interpretation training” according to the article published by Nursing World. It is especially important that the health care system diversifies its needs and provides proper training for health professions in culturally diverse situations. Professionally trained interpreters have shown to result in better patient understanding and improved rates of adherence for primary and preventative care. To improve interpretation services in health care systems, more state and government funding can aid in expanding this service. Although interpretation services are required to be provided by all healthcare systems, many health care providers fail to properly fund their service because translation services are not reimbursed by the government. This highly affects low-income individuals, many of which speak a different language. With increasing state and government funding, interpretation services can effectively lessen the health disparities mediated by language barriers. Vivian Hong is a sophomore at UC Berkeley majoring in Public Health and Media Studies. In her free time, she likes to watch YouTube videos, hang out with friends, and go to concerts. Currently she is involved with Mental Health Initiative and Health Leads. In the future, she hopes to work in the marketing sector for a health care start-up or consulting firm.

clothing-induced pollution: a rising threat

PAMEE SAPASAP contributing writer

ach season, the fashion industry releases a selection of styles that are admired, worn, and inevitably replaced a few months later in favor of newer, more stylish options. The demands of the dynamic and fast-paced fashion cycle are made possible by globalization, which has allowed companies to mass-produce large quantities of clothes at small prices. Though seemingly harmless, this practice of “fast fashion” has led to many adverse effects in our environment. The dyes that are used to color clothing are responsible for polluting countless rivers and lakes throughout the world. According to the Environmental Leader, approximately 17–20% of industrial water pollution is caused by dyes and other treatments being unleashed into fresh water sources. A prime example of this is the Citarum River, located in Indonesia, which is considered to be one of the most polluted rivers in the world after years of being used as a dumping ground for textile factories. According to an article published on EcoWatch, researchers found traces of lead, mercury, and arsenic, as well as a pH level “equivalent to that of lye-based drain openers.” These chemicals stay in the clothing and may require multiple washes to come out, which poses a threat to our health and to the survival of marine life in affected areas. Even after these chemicals wear off, clothes can continue to pollute the environment. The rapid production cycles and affordable prices of retailers such as Forever 21, H&M, and Zara have made clothes seem like a disposable commodity. As a result, more clothes are being discarded at higher rates than ever

before. According to the Council for Textile Clothing, of the 25 billion pounds of textiles produced by the United States each year, 15 percent is donated or recycled while 85 percent goes to landfills. When synthetic materials such as polyester and nylon reach the landfills, they produce methane similar to food waste, but, unlike food, the cloth take hundreds of years to decompose . Fortunately, some clothing manufacturers have started making efforts to become more environmentally friendly. In a 2015 article, Chemical & Engineering News reported that Adidas, Gap, Puma, Nike, and H&M were among the 25 companies who have joined the Zero Discharge of Hazardous Chemicals Program as a promise to suspend the practice of disposing toxic chemicals into water sources by 2020 . Other companies like Patagonia and The North Face have programs that accept used clothes to recycle or resell in their stores. Reuse at UC Berkeley is a student run nonprofit that has a similar objective. Located on the first floor of MLK, the organization accepts donations of clothes from students throughout the year and sells them back to the Berkeley community at affordable prices, ranging from $1-$3. They sell anything from jeans to jackets to accessories, and their office supplies are free. Students can sign up to be a volunteer at Reuse or get involved in other ways such as refashioning old clothes, going thrifting, or exchanging clothes with friends. Pamee Sapasap is a second year intended psychology major. After undergraduate school, she plans on earning a master’s degree in cognitive neuroscience from the University of Oslo and hopes to conduct research with language and memory loss. She is passionate about chai lattes, cooking, and Dr. Phil. the

PUBLIC HEALTH ADVOCATE // 33

social media and food trends

by LESLY ANN LLARENA and KAYLEY VAID

contributing writers

ating right is part of living a healthy lifestyle. Following a healthy diet early on in life has an impact on one’s health for the rest of one’s life. Dr. Michael Miedema, a cardiologist at Minneapolis Heart Institute conducted a study and found that the “[...] data highlights how important it is to start healthy eating habits early—not only because they tend to stick around through adulthood, but they can actually make a difference in the state of your heart”(Time). As young adults, college students still have time to change their eating habits. Social media can impact college students’ decisions of what and where to eat. They look for trendy locations, food places, and “must try” dishes. We conducted a survey of over 40 UC Berkeley students ranging from freshmen to seniors and asked them about how they would access their own level of health and 34 \\ FALL 2017

where they prefer to eat on and off-campus. We also inquired as to which social media platforms they believed were affecting their decisions of where and what to eat. About 70% of students found Facebook helpful when looking for a place to eat. In addition, Instragram was the second most helpful and Snapchat the third. While living on-campus, students have meal points and tend to feel limited in their options. When asked about which dining hall student preferred, Cafe 3 was selected by approximately 30% of respondents. Crossroads, which is also quite close to campus, came in at a very close second. Meanwhile Clark Kerr and Foothill dining halls, which are not as accessible were less popular choices. The dining halls seem to offer a little bit of everything. Crossroads is equipped with a salad bar and many entree options extending from pasta to chicken. But Crossroads also has the all too alluring dessert bar, ice cream, and pizza options that students may be tempted to dine on. Students were also surveyed about where they preferred to eat while on campus, and 40% chose Pat Browns.

Pat Brown’s offers many healthy eating options. “The Brown’s kitchen uses scratch cooking techniques to produce delicious vegetable-forward menu items as well as ‘better meat’ options such as grass fed burger”. Pat Brown’s offers a great way to use your meal points and still eat healthy. It is all about making decisions. Breakfast is known as “the most important meal of the day” and our survey of UC Berkeley students reveals that La Note is one of the most preferred places for breakfast in Berkeley. La Note offers a variety of breakfast options: pancakes, french toast, omelets, eggs, hot cereal, fruit, and pastries. A fruit salad cup contains about 60 calories, 16 grams of carbohydrates, and 1 gram of protein. Meanwhile, a cheddar omelet contains 480 calories, 4g of carbohydrates, and 20 of protein. Both a fruit cup, and an omelette fair as healthy options. However, a single piece of French toast—clocking in at about 220 calories, 23 grams of carbohydrates, and 10 grams of protein—might not be the most health conscious choice. Depending on what you order, La Note can be a very healthy choice, but that comes at a cost. La Note is extremely popular for breakfast and brunch, so make sure show up early to avoid long wait times! When it came to lunch, many of the students surveyed preferred Cheeseboard Pizza. Pizza is not the healthiest of foods with its high carbohydrate and calorie count. Per slice, Cheeseboard is about 280 calories, 10 grams of fat, 30 grams of carbohydrates, and 15 grams of protein. Cheeseboard Pizza, however, is unique in that their pizzas “never have meat and are topped with organic and local ingredients [...] Everything is made fresh daily”, according to their website. They have gluten free and vegan friendly options. Although pizza is not typically seen as a healthy choice, Cheeseboard Pizza provides a fresh and accessible option for pizza for UC Berkeley students. Based on our survey we conducted from UC Berkeley student body, Gypsy’s was voted to be the best place to get dinner with a 50% approval rate. Based on location, it is very accessible and convenient as the university dormitories are less than 3 blocks away. In addition, the price range is very affordable. Gypsy’s menu contains a lot of pasta which also means a lot of carbohydrates.Based on the National Institute of Health (NIH) News In Health, eating foods with low glycemic index prevents certain diseases, such as diabetes, cancer, and cardiovascular disease . A diet of pastas might not be the best way to stay healthy. Adding vegetables and protein may provide students with a more balanced diet. As for desserts, the majority of the student body chose

CREAM as their favorite spot for sweets. CREAM prides itself in serving vegan cookies, gluten free cookies, and gluten free ice-cream which makes it a go-to-place for everyone! They even claim to make their batches of cookies and ice cream fresh. CREAM is located close to campus and the dorms making it very convenient for anyone to grab a cold treat on a hot day. They are certainly an affordable option for a sweet treat. Not to mention there are many flavors to choose from, Most young such as the green tea flavored ice adults don’t cream. Although, these places have the time are delicious, students’ say they manage to burn off surplus to commit to calories by walking to class. eating healthy The students in our survey try their best to stay healthy. The at every meal ... majority of them find it difficult to maintain a healthy lifestyle. In reality, it can be challenging to eat right and live a healthy lifestyle due to the long hours students commit to working on projects, studying for exams, volunteering at clinics, holding jobs, and doing internships. Based on the the NIH article on “Work Hours and Perceived Time Barriers to Healthful Eating Among Young Adults”, finding the time to eat right plays a huge factor. Since most young adults don’t have the time to commit to eating healthy at every meal, they turn to fast food meals and indulge in an unbalanced diet which causes health problems in the future. The article even states that young adults fall far below the average when it comes to the consumption of fruits and and vegetables: “Cost barriers, stress, limited knowledge of how to prepare healthy foods, and taste preferences have been identified as barriers to healthful eating among young adults.”

Lesly Ann is a fourth-year undergraduate student studying political science. She is the President of Universities Allied for Essential Medicines at Cal, where they advocate for equal access to medications globally. In her free time, Lesly Ann enjoys watching medical dramas, cooking, and trying new restaurants with friends. She hopes to work in the realm of politics around Southeast Asia. Kayley is a senior Legal Studies major who has recently developed an interest in public health. She is particularly interested in how law and public health intersect. She plans to attend law school next fall and study public interest law. the

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malnutrition in orphanages

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SURINA KHURANA contributing writer

he early stages of an individual’s life are arguably the most important in laying the foundation for the rest of their life. The environment a child is raised in, who they are raised by, and how they are raised affect the child’s health in numerous, lasting ways. According to a report published by Elizabeth Mwaniki of the Jomo Kenyatta University of Agriculture and Technology in Nairobi, Kenya, millions of children lack resources critical for their nutritional health. “Recent research has shown that as many as 200 million children worldwide fail to reach their cognitive and socioemotional potential because of malnutrition, micronutrient deficiency, and lack of stimulation during early childhood,” Mwaniki wrote in an article published by the Journal of Nutrition and Food Sciences. While Mwaniki adds that school-age children are most vulnerable to udernutrition because the priority in nutrition intervention is often “to prevent malnutrition during fetal development and the first years of life.” Mwaniki’s assertions are supported by other researchers, too. Germine El-Kassas from Beirut Arab University and Fouad Ziade from Lebanese University conducted a study together where they measured children’s dietary intakes — this time of children living in orphanages in North Lebanon. Kassas and Ziade found that about half of their study subjects had “inadequate dietary intakes” of rudimentary components typical of a first world diet— proteins, fruit and vegetables. Furthermore, 92% of the participants Left: A young boy eagerly receives a slice of pizza from a U.S. Air Force captain on a visit to a Honduras orphanage. Below: A caretaker serves food to chldren in an orphanage in Sri Lanka. Orphanages in third-world countries have high rates of malnutrition.

did not meet the sufficient levels of dairy intake for their respective ages. While research and observation demonstrates poor nutritional intake for the majority of those living in impoverished third-world countries, these researches prove how nutritional deficiencies are inherent to orphans in such countries. An article published in the International Journal of Environmental Research and Public Health further expanded on Mwaniki’s claim. The author asserts that internationally adopted children are generally more likely to exhibit signs of malnutrition and thus impaired growth than children adopted in the U.S. “Studies have confirmed that children who have spent early time in institutionalized settings have signs of growth deficiency and developmental delays,” the author writes. “Some studies also compare growth and child development in foster care versus orphanage settings. These results support the idea that being raised in a family-like setting ... is better for nutrition, growth, attachment, and development.” While orphaned life certainly impacts children biologically by failing to provide sufficient nutrients, it also impacts children’s social and psychological development. These aspects can still influence the child’s overall health and how they act in the presence of food. “In some cases, if the conditions are poor or the budget is tight, an institution may feed its children a limited diet, in which case, their exposure to tastes and textures will be minimal,” according to an article published on adoption.com, a website that hosts an online platform for connecting adoption families to adoptees. “In other cases, there may be many children to feed and a limited staff to feed them, which leads to uncertainty on the waiting childrens’ part. And in other cases, if an orphanage lacks structure, children will develop poor eating habits right off the bat because of their uncertainty as to when mealtime will be.” Thus, children — whether in third-world countries or developed, first world countries — are constantly affected by inconsistencies in orphanages. While an individual may only stay in an orphanage for a small fraction of their life, it can ultimately impact their health in countless ways, possibly for the entirety of their adult life.

Surina is a first-year student intending to study public health. She is interested in examining how socioeconomic resources affect one’s access to healthcare. In her free time, she enjoys playing volleyball, spending time in grassy areas, and telling corny jokes. She hopes to open her own vegan bakery one day. the

PUBLIC HEALTH ADVOCATE // 37

The Expense of Hate Crimes by

KRISTAL LAM and HEATHER ZHANG contributing writers

ith much political outrage, there have been common outbreaks of riots here in Berkeley, and this could be affecting the public health of our campus community. Since President Trumpâ&#x20AC;&#x2122;s election, more activists have been targeting minority groups. According to PBS, just 10 days after Trump was elected to office, 900 hate crimes against minorities emerged across the country. Since then, the number has died down but they arise here and there, not excluding our very own City of Berkeley. Hate crimes are not only affecting the safety of the campus, but they are also contributing to already existing disparities of health in minority populations. Several medical organizations, including the American Psychological Association, the American Medical Association, and the American Academy of Family

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Physicians, have officially declared hate crimes a public health issue. The events in Charlottesville, Virginia this past August demonstrate how minorities are negatively affected by hate crimes. A car driving directly into a crowd of protesters produced several injuries, ranging from minor lacerations to deaths. Unfortunately, following the incident in Charlottesville, a rally of similar advocacy was planned to take place here in Berkeley. As left-wing protesters rallied against the hate, Berkeley police resorted to tear gas to disperse the crowd. While Hate crimes are not only there is no evidence affecting the safety of that minorities the campus, but they were targeted with the tear gas, it is are also contributing to because these rallies already existing disparities are targeted toward of health in minority minority groups that they are more populations. likely to be involved with such incidents in which harmful conditions are present. Here on campus, minorities make up about 18.5% of the population. While not everyone participates in the rallies against hate crimes, imagine the possibility of all 18.5% being targeted with harsh words and actions. On top of that, the U.S. Census shows that the majority of those without health insurance in California come from minority groups. With a lack of health insurance, violence only adds to health disparities between populations. For the safety of our student population, more research must be conducted to analyze the impact of

While it will take time to control the hate crimes around the world, we as a campus can work together to maintain the peace here in Berkeley.

hate crimes and to figure out how to prevent them. When it comes to hate crimes, minorities are assaulted because of their race or ethnicity. The American Journal of Public Health has discovered that they actually suffer additional emotional, physical, and psychological effects as a result of discrimination. There are several educational programs that are directed at the prevention of hate crimes. Some involve having a discussion, where different groups come together to hear each otherâ&#x20AC;&#x2122;s perspectives. Recently on Sproul, a tent was set up for people with different political beliefs to peacefully talk. However, this will not prevent the occurrence of hate crimes. While talking with people who have different perspectives is a step towards peacefulness, some may be unwilling to listen. Another solution is to legally identify what a hate crime is and pass legislation relating to it. The American Public Health Association (APHA) launched an initiative called the National Campaign Against Racism. With this initiative, APHA plans to establish that racism affects public health and research how in

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order to initiate change. While it will take time to control the hate crimes around the world, we as a campus can work together to maintain the peace here in Berkeley. Take some time to actively listen to what student organizations such as the Black Students in Health Association, the Chicanos/Latinos in Health Education, and the Pilipino Association for Health Careers have to say. They host an annual Minorities in Health Conference that can provide us with some perspective on what we can do to make our campus a safe space for everyone.

Kristal is a second-year student majoring in Molecular and Cell Biology. She is interested in the medical field and is currently working as an EMT. In her free time, she likes to binge watch Netflix and take naps with her puppy, Ross. Heather is a second-year student interested in public health and economics. Along with The Public Health Advocate, sheâ&#x20AC;&#x2122;s also involved in Cal UPHC. In her free time, Heather enjoys playing with her dog, watching Netflix, and eating.

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