Back!

And where to start? I have a whole slew of notes from the conference that I want to record here, but that's mostly just for me, so I don't have to keep track of a dozen little scraps of paper, and I imagine will be relatively boring for the rest of you. But then there are also little personal updates which, if I tell the story chronologically, will be sprinkled throughout the boring bits, which I'd prefer not doing to you, dear reader...

Well, I'll start with April, who was kind enough to share her adorable studio apartment with me for an entire week. She messaged me my first day back here, "Seemed so damn normal having you around..." And she's right. Much like my stay with AWB last summer, this trip was particularly well-timed, in a mental health sort of way. April and I are both sort of fucked up (in a fairly classic, everyone by this point in their lives has baggage/needs therapy sort of way) and we both agreed that the nicest thing about being around each other is that there's no need for either of us to be 'on.' It takes no effort to be in front of each other. Which we both certainly needed. And it was nice to have that chummy sort of roommate thing happening again. Don't get me wrong, my current roommate is lovely, and we're highly compatible. But not particularly close emotionally. And after AWB and PC I'm highly spoiled. So it was nice - April would sing to me in the morning to wake me up and fed me snacks while we got ready to leave. We said I love you and linked arms and talked seriously and not seriously and snuggled on the fouton. It was, all around, a lovely time.

I also got to see my aunt, and meet the new person in her life. I think my aunt is the greatest, but I found myself wishing this week that we had the chance to start over. I think we have a lot in common, and I think we have the potential to be really close, but there's all this family baggage getting in the way, straining our interactions. Blah.

And I got to hang out with my cousin (it was a whole little family reunion!) who was in town for a math and science competition at MIT (yes, we're all big geeks). His team project was about modeling the spread of infectious disease, so of course I was totally excited.

During my time off from the conference I walked part of the Freedom Trail, which was cool and inspiring, despite the constant downpour. I was particularly bummed to have forgotten my camera when I got to the Paul Revere Mall, as the trees had blanketed the area in bright yellow leaves and it was all very pretty. I somehow manage to forget sometimes just how old Boston is. I always get a little weepy and patriotic in DC, and it was nice to get that same feeling in Boston. After getting un-soggy I caught up with Steve for a very nice dinner (and an excellent bottle of wine - what was the type again?). The next day I wandered all over town and did a little shopping and finished up in the public gardens, where I got all nostalgic about Make Way for Ducklings. That night April and a bunch of her friends from the kickball league and I went to see Edan and Cut Chemist. The latter was all right, but I was impressed enough with the former (who are eerily like an American version of The Streets, but arguably somewhat less talented) to buy their CD on the spot.

The conference itself was grand, and very much nerd hollywood. I got to see Paul Farmer (and snuck April in for his keynote address) and Paul Hunt, who wasn't on the schedule, so I did the hugely dorky fangirl gasp when I walked into the room and saw him sitting on stage ("As a guest in your country, and not having been invited by your government, far be it for me to suggest that any of this applies to the United States." followed by talk about health disparities, mental health, AIDS, healthcare/insurance). Oh, and I schmoozed like a champ with the statistics section (they even asked me to contribute a paper for next year).

On to the boring stuff:

Helene Gayle, CARE
"poverty is a fatal disease"
you can't just deal with the consequences of pverty, that's not sustainable
just as public health requires prevention, we need to prevent poverty by attacking the root causes
use a rights based approach to be not just against inequity but for justice
women and girls make up 70% of those living in extreme poverty (< $1/day)
women produce 50% of the food, worldwide, but own less than 1% of the farmland
every year that a girl goes to school infant mortality decreases by 5%-10% (without any direct health interventions)
more female education leads to more efficient farming and decreased malnutrition rates in men

Paul Farmer - "Last time I checked, the treatment for hunger was food."
why isn't it sustainable to pay community healthcare workers, when international consultants from wealthy, developed countries receive plentiful salaries?
why are there HIV/AIDS programs that provide anti-retrovirals for free, yet ask people to pay for condoms?
NGO-land doesn't need to be expanded - the public health sector needs to be strengthened, because only governments can ensure the rights of people
Where American doctors outnumber African, what is the long term plan? How is that sustainable?
When people aren't facing destitution and disease they may be able to participate civilly and politically (though affluent democracies may disprove this hopeful theory)
XDR-TB - Extensively drug resistant tuberculosis
equality and justice are the price we pay for sustainability and cost effectiveness

David Williams, Harvard, health disparities
43% of all children growing up in poor or near poor households
in the United States this stat is strongly linked to single parent households, but it doesn't have to be - In the US 19% of all households with children are single parent households, and 55% of those are living in poverty; in Sweden 21% of all households with children are single parent households, and 7% of those are living in poverty - because Sweden made specific, intentional policies (mostly financial) to break the link between family structure and poverty
residential segregation, Harvard research, look into as possible causal effect stuff

Gayle, health disparities
"We do not have the luxury of false dichotomies." we have to work with people we don't like, with people who traditionally have not acted in ways we want, to achieve progress
it took 5 presidential administrations to create Medicaid - progress is SLOW
"Place Matters" study - in Dekalb county?

Larry Adelman, producer 4-part PBS series on health disparities, fall '07
"evidence is rarely, if ever, enough to catalyse political action." - WHO report
the inability to control forces in our lives result in unequal health outcomes
since aspirin cures fever, lack of aspirin must be cause of fever - analogous to belief that since healthcare can cure disease, lack of healthcare must be cause of disease --> universal healthcare is great, but won't solve all problems because not root cause of problems
1908 Supreme Court ruling in Arizona upholding native american water rights was just never enforced
the prosperity of Arizona was built on the backs of the health and well being of native americans
government subsidized food for tribes did not include fresh fruit until 2004
rates of diabetes in native americans skyrocketing

Military, torture, human rights - George Annas, Steven Miles, Grodin
where were the doctors at Abu Graib?
physicians are the frontline defense for human rights, they see prisoners the Red Cross and other NGOs can't get to
records show there was a nurse who failed to act in at least one specific Abu Graib situation
60% of torture victims report seeing a healthcare professional either present or involved in their abuse
maybe only if you're in a permanent vegetative state do you have a right to food and water (comparing Schiavo to Katrina)
US Social Forum, Atlanta, July '07
50% of polled physicians believe their is no duty to treat (audience member commented on failure of education, loss of idealism during med school)
if you can keep utilities running you're preventing people from dying for a lot of reasons other than the specific emergency at hand - i.e., perhaps utility workers should be considered critical first responders, in addition to fire, police, emts, etc.

Ethics and public health - Thomas May, John Parascandola, Angus Dawson, Kathleen Powderly, Joanna Weinberg, Salaam Semaan
1940s VD poster - "She may be a bag of trouble..."
rapid treatment centers created during WWII to hold (often involuntarily) women suspected of having VDs
what do you do if there is parent-child disagreement regarding the HPV vaccine?

Health Disparities - Creshelle R. Nash
of all populations only 54% of patients receive recommended care - focus on disparities alone only part of the quality improvement picture
much less known about successful interventions to reduce/eliminate health disparities, need to work on evaluating interventions - could add this to conclusion of my paper, need to talk about measurement of different before can evaluate effect of intervention

Instrumental Variables
a good instrument is hard to find, you need strong effects and/or large sample size (preferably both)
instruments are often policies or legislation
basically need to ask what affects an individual's exposure?
require same independent and non-differential assumptions as classical measurement error models (i.e., would need modification for my problem)

SEM - Ruth L. Eudy
references on statistics.com
generally want large sample size (> 500) for SEM
interesting organizational structure - presenting 'substantive' hypothesis and 'methodological' hypothesis
SEM also more difficult with multiple control variables

note to self - consider joining UN Association