The New Us? | The Turning Point

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History teaches that population-wide behavioral patterns change infrequently, and slowly. After all, little changed in how we behaved after the last global disease disruption, the flu pandemic of 1968, and perhaps most dramatically, societal behavioral changes after the 1918 flu pandemic were few and far between. What is most striking about how we act in the future is how similar our behavior looks to what it was like in the past, and that is true whether we have lived through a national trauma or not.

What did change after the 1918 flu pandemic was our appreciation of the need to move beyond considering health as an exclusively individual responsibility, and to set up the structures needed to help promote health collectively. A number of countries created health ministries after the 1918 pandemic and centralized healthcare delivery schemes, which unfolded in different ways in different nations. Russia, for example, was first to follow the 1918 flu pandemic with public healthcare, funded through state-run insurance. The UK, France, and Germany did much the same soon after. In 1922, the League of Nations Health Committee and Health Sections were established—forerunners of the World Health Organization (WHO).

Read the full piece on The Turning Point.

The Respiratory Scoreboard | The Turning Point

On February 24, 2020, the first documented U.S. case of community transmission of Covid-19 was reported from a specimen collected by the Seattle Flu Study. The Seattle Flu Study was designed as a surveillance of persons reporting respiratory symptoms. In a normal year it detects high rates of influenza, particularly during winter months—most years, influenza sickens hundreds of thousands of Americans and kills 30-50,000. But this has been anything but a normal year. Even as the surveillance system has been picking up Covid-19 cases, of the thousands of nasal swabs the research team has analyzed, an extraordinarily low number have tested positive for influenza.

Covid-19, like influenza, is a virus that moves through the air. We might have expected that with so much Covid-19 around, flu would be a fellow traveler, likewise infecting millions of Americans. But the only virus that’s had a successfully infectious year in 2020 was the new Covid-19. Other respiratory viruses have been rarer this season too, such as respiratory syncytial virus, parainfluenza, and even other coronaviruses that cause common colds. It’s not easy to find people with the coughs, running noses and fevers, typical this time of year, who are not singularly infected with Covid-19.

Fear in a year of pandemic | The Healthiest Goldfish

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I am afraid of a lot of things, though probably not more than the average person. I really do not like small closed spaces, and I have a disproportionate fear that any ache and pain can become a terrible illness. I fear economic insolvency. And I have been thinking a fair bit about these fears in the time of a global pandemic. Fundamentally, I have been trying to ask myself: what role does (or should) fear play in our decision-making? How do we reckon with the role fear plays in shaping our choices?

If you live in the US, your odds of being killed by a foreign-born terrorist on American soil are one in 3.64 million. This places risk of death from terrorism far below that of other causes of death, such as, for example, drowning, which is fifth among leading causes of unintentional injury death in the US. Yet drowning risk has not shaped our politics and society for decades, motivated sweeping legislation like The Patriot Act, or helped provide justification for an annual defense budget of roughly $700 billion. This is arguably because drowning, while more widespread, does not receive the same publicity as terror attacks, allowing terrorism to generate a fear disproportionate to the risk it poses. 

Read the full piece on The Healthiest Goldfish.

POV: Biden’s Gun Control Executive Orders Are a Step in the Right Direction | BU Today

The recent mass shootings in Colorado and Georgia are tragic reminders of something we have long known: America has a gun problem. Each day, over 100 people in the United States are killed by guns, and over 230 are wounded. We face an average of 38,826 gun deaths each year, about two-thirds of which are suicides. These ongoing daily tragedies have formed a kind of white noise in the background of our national life. To our shame, we have become so accustomed to it, we sometimes forget it is there—until another horrific mass shooting breaks through and reminds us. Gun rights have become a grotesque parody of their original intent. The “well regulated Militia” specified in the Second Amendment has become the active shooter in the shopping mall, spa, or school, the toddler accidentally discharging her parent’s gun, the depressed individual turning a pistol on himself.

This problem has been prolonged and deepened by long-standing intransigence at the federal level. The success of the gun lobby has been a triumph of special interests over the will of the American people, the majority of whom favor common-sense gun laws. According to a 2019 Pew Research Center poll, 60 percent of Americans favor stricter gun laws, an increase from 52 percent in 2017.

In recent years, calls for action on guns have grown louder. The 2018 Parkland, Fla., shooting, in particular, catalyzed a new approach to the issue of gun violence, led by young people, notably reflected in the March for Our Lives.

The Price of Health Equity | JAMA

The core goal of individuals working in the population health enterprise should be to improve health for all. There are many formulations of this fundamental aspiration,1 but it is unlikely that there is much disagreement about this general notion among researchers and practitioners in medicine or in public health. Over the past few decades there has been a growing awareness of the health gaps between groups, often characterized as health disparities or health inequities across the axes of race and ethnicity, socioeconomic status, and sex among others.

Black US residents live shorter lives than their White counterparts, and they are sicker throughout life. The richest quintile of US residents can expect to live 1 decade or more longer than the poorest quintile.2 Despite improvements in health over the past several decades for the richest 20%, many measures of health have worsened for the poorest 80%.3 The focus on health inequities has grown and sharpened during the past year as issues of racial justice more broadly have risen in the public consciousness, triggered by the killing of George Floyd and the subsequent civil protests that followed—the largest such protests in US history.

Liberty and health? | The Healthiest Goldfish

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I was in New York City on September 11, 2001. I remember the event and its aftermath. I recall that the fear in the city was palpable. In the days after the attacks, I started to see this fear reflected at the national, political level, among lawmakers, and eventually in the laws they passed. The Patriot Act, passed with near-unanimous support in the Senate, emerged from this climate of fear.

There is much about the Patriot Act which has since been rethought. It has been seen as at best an overreach and at worst Constitutionally dubious, leading to no-fly lists and the discriminatory targeting of Muslims. Given how controversial it has become, it is important to remember how reasonable the Act seemed at the time it was passed, how, gripped as we were by fear, we were able to see its broad provisions for the pursuit of terrorists as a rational response to the threat we seemed to face.

Nearly two decades after September 11, 2001, March 2020 put us in a similar state of fear, with the emergence of a novel pathogen that would eventually reach a point where it would kill each day roughly as many Americans as 9/11 did. As the new coronavirus swept the world, the fear of it was amplified across a range of media. Headlines from that time reflect how quickly we came to see the virus as a threat:

“Experts worry about pandemic as coronavirus numbers increase: report,” in Fox News on February 3, 2020.

Read the full piece on The Healthiest Goldfish.

Health and the opportunity to freely think | The Healthiest Goldfish

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I was never really supposed to be able to do what I do for a living. Where I grew up, the notion that one could find gainful employment by having ideas and working to develop them in the academic space was close to inconceivable. On the island of Malta, where I am from, during the time I lived there, there were really just three options for the intellectually ambitious: doctor, lawyer, or priest. I initially chose doctor, but, over the decades, this role evolved into a privileged position of being able to work in academic public health, where I get to help inform a conversation about how to build a healthier world. Had my teenaged self been able to see into the future and glimpse what I am doing now, he would have been quite surprised.

The longer I do this work, the more I am struck by how extraordinary it is that anyone gets to do it, let alone me. One is reminded of Maslow’s hierarchy of needs, with the basics of food and shelter at the bottom, and engagement with meaning and ideas located somewhere near the top. For much of human history, it has been all most people could do to satisfy foundational needs, to access the material resources necessary to keep body and soul together. That we now have a society which supports the pursuit of ideas as a viable career path is a rare and fairly recent achievement in the grand scheme of history.

Read the full piece on The Healthiest Goldfish.

Welcome to the Gun Show | The Turning Point

This month, with the terrible killings in Atlanta and Colorado, gun violence returned to the evening news. With in-person congregation mostly eliminated due to the pandemic, it seemed as if there were no shootings in 2020—in schools and public buildings and houses of worship—like those that have filled our television screens for decades. Yet in 2020, with much of the population staying at home, the number of mass shootings (at least four victims wounded) exceeded the year-end totals of the previous five years. With 20,000 dead from guns, Covid-19 did not slow the gun violence trend of the past decade. In frequency, fatalities, and injuries, gun violence during this past year has been hideous.

Indeed, 2020 was the highest gun sales year ever. There were two million guns sold in March 2020 alone, the second busiest month in history, the same month that Covid-19 rates first rose. First-time buyers drove this burst. Americans feared crime waves, police depletion, government repression, and sales persisted throughout the year. Americans stockpiled military weapons and high-volume gun clips. The background check system foundered under record-breaking business. The recorded numbers included only known gun sales; sales of unregistered guns, those bought at gun fairs, and online “ghost guns” assembled by the purchaser, are not tracked.

This is the personal website of Sandro Galea. All photos are taken by Sandro Galea.