I got an important note from a friend the other day about the comment period for the WIC program. Comments can be made until Monday, November 6 about proposed changes that would greatly improve the program – changes that will finally allow fruits and vegetables, whole grain products, and dairy alternatives to be part of the food package. (I know, it’s shocking that they haven’t been up until now.)

It’s super quick and easy to make a comment in support of the changes. Go to the National WIC Association page and click on the link to send a comment of support. I used the “Click here to send an electronic grassroots campaign letter” link. Their pre-fab message is simple and concise.

Here’s a little more background: WIC (Women, Infants, and Children) is a nation-wide program under the US Dept of Agriculture that provides nutrition education and counseling and referrals to health and social service providers to lower income pregnant women and children under age 5. WIC serves one-half of all infants in the U.S. and 25% of all children under age 5. Amazingly enough, the food package it offers hasn’t been changed in 30 years. In its current form, it provides a lot of cheese, milk, and eggs, it doesn’t meet current dietary guidelines, and it doesn’t allow for food preferences of different cultures. And it seriously does not include fruits and vegetables.

The proposed changes will add fruits and vegetables, whole grain foods (bread, cereals, tortillas and rice), and dairy alternatives like soy milk and tofu to the food package. My friend comments that an added benefit is that this will provide an incentive to smaller food stores in areas where there is not a lot of access to fresh fruits and vegetables. The changes seem to be based on an ’05 Institute of Medicine Report (WIC Food Packages: Time for a Change).

I’m sure there are many additional improvements that could be made, but this seems like a really big step in a vastly improved direction. Please take the few seconds needed to send your support.

I asked Berliner to comment because he authored another important book on the role of big philanthropy in shaping medical education and the medical research agenda. A System of Scientific Medicine: Philanthropic Foundations in the Flexner Era (New York: Tavistock, 1985) came out six years after Richard Brown’s controversial Rockefeller Medicine Men, which I wrote about a little last week, and which Berliner reviewed favorably (along with two others) at the time for the Bulletin of the History of Medicine. (The reaction to his review from the Bulletin’s editor review is a fascinating story for a forthcoming post and will answer a few questions I’ve received about the reaction to Brown’s book.)

And if you missed it last week, here’s Anne-Emmanuelle Birn’s Lancet commentary on the Gates Foundation’s health programs, discussed by Berliner below.

Here is Prof. Berliner’s commentary:

The Gates Billions

The recent announcement that Bill Gates is stepping down from his Microsoft position to play a greater role in his foundation and the subsequent announcement that Warren Buffet is giving $31 billion to the foundation (of which he is a board member) has certainly set the philanthropic world aflutter. The largest foundation ever, with more money to distribute than the United Nations and largely focused on areas of public health (both topical and geographic) that get little other support.

In the early 1900’s, the gifts of John D. Rockefeller to international public health not only created the initial schools of public health ( e.g., Johns Hopkins), but also brought new medical discoveries to large segments of the world that had no other way of obtaining them. The initial analysis of the Rockefeller gifts was explained in terms of religious obligations and the needs of the wealthy to help the poor, if only to further their entrance into heaven. Later analyses, by myself and E. Richard Brown, among others, looked to the way that the philanthropy eased the inroads of western business into hostile areas and how the gifts ultimately led to the expansion of markets.

At the time of the Rockefeller philanthropies, much of the criticism was based on the notion of “blood money”– the Rockefeller money had been expropriated from workers, many of whom died in the struggle to achieve better and safer working conditions and a living wage. Anyone who used the money had the blood of those workers on them. While this argument never really went away, it never stopped anyone from accepting the money either.

The best arguments against the Gates Foundation money have been laid out by Anne-Emanuelle Birn in her piece in the Lancet. But critiques from the left seldom have much weight when contrasted with the clear and vast needs of the populations that will receive the largesse.

One could argue that the Gates money is going to areas that western philanthropy has long ignored, that the United Nations, IMF and World Bank have little interest in, and for which the governments of the countries affected have few resources to spend. Therefore, the Gates money should be welcomed. But the existence of the Gates money has the paradoxical effect of keeping other potential funding away from the problem. Why should a government waste scarce resources on Malaria if the Gates Foundation is willing to step in?

It is hard to ignore the role of such funds in a neoliberal universe where NGO’s are the rule, yet the consequences of the Gates Foundations could be quite dramatic. As Birn notes in her piece, the Gates approach is to use high technology– find cures for diseases, vaccines, pharmaceutical solutions, as well as less high tech approaches – mosquito netting, for example. Yet, the focus on health care issues belies the needs for essential infrastructural development in third world countries. Without a better base in agriculture, the impact of success by the Gates Foundation (and others working in the same fields) will be to increase the numbers of people subject to starvation. Without better primary health care systems, success in any one disease will be mitigated or negated by the inability to deal with more common health problems. In his recent book Planet of Slums (Verso, 2006) Mike Davis presents a horrendous picture of the growth of cities without access to basic services and the absence of any systems to provide either jobs or nutrition for residents. The growth of automobile traffic, high levels of air and water pollution from manufacturing industries, substandard housing and inadequate nutrition will all create public health problems that will take greater resources than the Gates Foundation to solve. But who will take on that role?

One can trace AMSA back to two organizations, the Interne Council and the Association of Medical Students, which were formed by liberal/left/progressive interns and medical students in the early 1930s. In 1941, the two merged to become the Association of Interns and Medical Students (AIMS). With the ascendance of post-WWII Cold War culture, AIMS soon grew heavily stigmatized, especially when it came out in favor of national health insurance in 1948 and began associating, rather naively one must say, with a couple international student groups of certain ideological bent. In 1949, it severed ties with said groups, but the decision came too late. The same year of the NHI resolution, the AMA had passed this resolution:

“WHEREAS, The Association of Interns and Medical Students and the Association of International Medical Students are exhibiting communistic tendencies in their organization; and

WHEREAS, The American medical profession is opposed universally to any organizatoin which advocates the overthrow of the United States goverment by force and violence; and

WHEREAS, These intern organizations and medical students favor strikes that are upsetting to proper medical education; and

WHEREAS, It is said that these organizations have communistic affiliations; there be it

Resolved. That our Council on Medical Education and Hospitals is requested to investigate these organizations as to facts, tendencies, affiliations and objectives, and that a report of the findings of the Council be given to the House of Delegates at the earliest opportunity.”

Yikes! In 1950, the AMA formed the Student American Medical Association (SAMA) as an alternative to AIMS, which soon disappeared from the landscape. As you you can see on AMSA’s own site, SAMA eventually severed ties with the AMA and became AMSA as it exists today. And now you know its genealogy and origins in McCarthyism. If you want to know even more, feel free to e-mail me at merlin@healthmongers.org for an earful (sp?).

(Note: I have several friends in AMSA and think the organization does great work — so this capsule history is not meant to reflect badly on the organization TODAY in any way.)

(Note II: A Healthmongers informant and wise elder shares recollections from the 1960s of the Student Health Organizations (SHO)’s baiting by the Association of American Physicians and Surgeons, which mentioned him by name. I’ll try and dig that up if time permits. And speaking of prominent people who came out of these groups, some of the most distinguished names in post-WWII American medicine were once active in AIMS, but I’m not 100% sure how they’d feel about their names appearing here.)

Excerpt:

Although the money will not change the foundation’s larger goals, Mrs. Gates mentioned yesterday that it had been moving quietly for the last 18 months into microlending, which is the granting of small loans to poor people so they can start small businesses. A microloan of less than $50 might finance, for example, the purchase of a loom or a set of bicycle repair tools.

Here is a criticism of the assumptions behind micro-credit. It doesn’t specifically address public health problems and was written a while back, so the data’s outdated, but the analysis itself is certainly not. I’ll post more recent criticisms as I locate them. The author is Gina Neff, a very sharp economic sociologist now at the University of Washington.

Excerpt from The Times piece:

Warren E. Buffett’s $31 billion gift to the Bill & Melinda Gates Foundation will help the foundation pursue its longstanding goal of curing the globe’s most fatal diseases, Mr. Gates said yesterday, along with improving American education.

The foundation hopes to use the enormous gift, among other things, to find a vaccine for AIDS, Mrs. Gates said. And Mr. Gates went further, saying that while he might be “overly optimistic,” he believed there was a real shot at finding cures for the 20 leading fatal diseases, as well as ensuring that every American has a chance at a decent education.

“Can that happen in our lifetime?” Mr. Gates said, sitting next to Mr. Buffett at the New York Public Library, where the gift was formally announced after news of it broke on Sunday. “I’ll be optimistic and say, Absolutely.”

Their approach, however, does not seem to prioritize infrastructural transformation that much:

Rather than spend every cent on fruitlessly trying to rebuild broken health care systems, the Gates Foundation follows a pattern of spending generously to chase solutions like a malaria vaccine. It also buys supplies, like vaccines or mosquito nets, but then tries to get rich countries to match its donations and poor countries to get organized well enough to distribute the goods.

That said, I’d like to stake out a position more nuanced than what might be called hyper-pharmo-scientism and its exact opposite, knee-jerk dismissal of these programs as nothing more than more extension of neoliberalism. In the past year, I’ve run across two thoughtful pieces: Anne-Emmanuelle Birn in The Lancet on the Gates Foundation’s health programs and Doug Henwood in the International Journal of Health Services on Jeffrey Sachs’s recent The End of Poverty.

Excerpt:

This year’s Videoconference opens with a June 26th broadcast from the UNC-CH Sonja Haynes Stone Center for Black Culture and History (SCBCH). Topic: Race-Specific Medicine, with Joseph L. Graves, Jr., Ph.D. Pilar Ossorio, Ph.D.,J.D., Morris W. Foster, Ph.D. , and Stephanie L. Crayton, Moderator

The June 28th session will be broadcast from the Carl J. Murphy Fine Arts Center at Morgan State University. Topic: “Tobacco Use Prevention Initiatives at Historically Black Colleges and Universities”, with Adrienne Y. Witherspoon, B.A., Michelle Cotton-Laws, Sharon Fryar Height, B.A. , and Allan S. Noonan, M.D.,M.P.H., Moderator The session will conclude with remarks by Helen Lettlow, Dr.P.H.

The page for this project is here. I assume it will be archived for those who do not plan on watching it live. The page also contains background readings for each panel. The Social Science Research Council also posted some online papers on this topic, targeted for a general audience, at this page. I particularly recommend those by Nancy Krieger and Jonathan Marks, whose What Does It Mean To Be 98% Chimpanzee? is written in the vein of Stephen Jay Gould’s classic Mismeasure of Man and raises critical questions about the ideology behind the genomics revolution.
Check out Marks’s list of articles here if you’d like to read some short pieces by him.

Excerpt:

New Yorkers experienced NPD at rates 60 percent higher than the rest of the nation. Certain populations in the city suffer from particularly high levels of NPD: adults between the ages of 45 and 64, women, Hispanics, individuals who are divorced, widowed, or separated, and those with incomes below $25,000. New Yorkers who reported being in fair or poor health were nearly three times more likely than other New Yorkers to have NPD.

The authors, who surveyed nearly 10,000 people in both 2002 and 2003, cite several possible explanations for why New York City residents have higher NPD rates. People who are low-income, unemployed, in poor health, unmarried, and/or lack medical insurance are at greater risk for NPD, and such populations are prevalent in New York City. That the survey was conducted in the aftermath of the September 11 terrorist attacks may also explain the elevated mental distress in New York City. “It is likely that some of the psychopathological consequences of the attacks contributed to the NPD documented here,” said lead author Katharine McVeigh, PhD, MPH, a Psychiatric Epidemiologist in the New York City Department of Health and
Mental Hygiene.

Although the study only appears to cover 2002-2003, the public mental health infrastructure has been inadequate for far longer (and far before the WTC attacks). De-institutionalization in the late 1970s/early 1980s and the resulting closure of “warehouse” facilities did not result in positive and comprehensive alternatives. For a recent overview of these problems, see these testimonies at the New York State Office of Mental Health’s website.

It’s important to remember these conditions amidst all the boosterist talk of urban revival and thriving big cities proferred by organizations like the Manhattan Institute and certain social scientists.

In the late 1970s, he proposed “a bill to establish a United States Health Service to provide high quality health care and to overcome the deficiencies in the present system of health care delivery,” better known as the “Dellums Bill.” Dellums understood that, critical as universal coverage through national health insurance was, it served only as a starting point to a new system of care. As the financial crisis has grown worse, I think the public conversation has shifted so much around the insurance issue that the general public forgets that there are so many non-fiduciary qualitative issues at stake as well.

Below is an excerpt from one version of the bill, which was written with the help of NYC health policy gurus Robb Burlage and Leonard Rodberg. You can read it in full here. If it seemed quixotic then, it seems even more so now, but it remains a positive vision of what an ideal and democratic health system might one day look like. As for Dellums himself, he always knew the bill had no real chance of passing, but explained that it was “essential for a progressive to advocate from the left and to offer a principled alternative for debate and vote, and to work to shift the center of that debate.” (quoted in Alan Derickson, Health Security for All: Dreams of Universal Health Care in America (Baltimore: Johns Hopkins University Press, 2005), 145.)

Excerpt from the Dellums Bill:

Enumerates the basic health rights which the Service shall ensure in the delivery of health care services to users, including: (1) the right to receive high quality health care and supplemental services without charge and without discrimination; (2) the right to choose the health workers from whom, and the health facilities in which, health care services are received; (3) the right of access to all health information and the right to have such information translated into the individual’s primary language; (4) the right to an explanation of the benefits and risks involved in the delivery of health services; (5) the right to have all documents treated confidentially; (6) the right, in the event of terminal illness, to die with a maximum degree of dignity; and (7) the right to legal assistance to enforce these rights.

Amends the Fair Labor Standards Act to entitle each employee of an employer subject to such Act to compensation for one hour at regular pay for each 35 hours of employment for the purpose of receiving necessary health care services.

Provides that all individuals while within the United States and its territories are eligible to receive health care and supplemental services under this Act. Specifies the services which the Health Service shall provide, including: (1) health education programs; (2) preventive services; (3) emergency medical services; (4) comprehensive outpatient and inpatient services; (5) occupational and mental health services; (6) dental care, long-term care, and home health services; (7) specialized therapies; and (8) the provision of drugs, therapeutic devices, and other medical equipment and supplies. Enumerates the supplemental services to be provided by the Service, including: (1) ambulance and other transportation services; (2) child care services; (3) home health services; and (4) counseling and social service assistance.

Requires each community board to establish community health care facilities to provide (to the greatest extent feasible through a single comprehensive health center) specified primary and specialized health care services.

Requires each district board to establish, within its district, a general hospital for the delivery of general health care services and those specialized services which may be provided most effectively at the district level.

Requires each regional board to establish a regional medical facility for the delivery of highly specialized health care services to individuals residing in the district.

Enumerates additional duties for each regional, district, and community health board, including: (1) education on personal health matters; (2) referral services; (3) environmental monitoring services; (4) research and data-gathering; and (5) follow-up services.