Monday, January 30, 2012

Happy Meal Turns "Crappy Meal" in SF

I have been writing a lot about healthy foods lately, including the provision of more healthy lunches in schools. But it has also occurred to me that I ought to qualify my fervor by stating that in general, I don't think the government should be telling us what to eat. It may be for our own good to consume healthier foods, and it may even be better for society as a whole. But in my opinion, individuals should be free to make their own priorities on something of this nature. So while I support healthy choices, I would like to keep those things as choices.

School lunches (about which I wrote in my last post) are a very specific subset of food. Since the government largely subsidizes public school food and even offers free lunch for those who qualify, what is served in school cafeterias could be broadly classified as the government providing the food for our nation's children, not just allowing it to be served. In that case, I think the government and schools should do what they can to provide nutritious meals rather than junk. Parents still have the option to send their kids to school with something different, so I don't really see this as a mandate on our behavior.

Recently, however, my dad mentioned that San Francisco passed a law forbidding McDonald's and other such establishments from providing free toys in their Happy Meals. I checked it out, and CNN says it's a legitimate story! The law took effect December 1, 2011, and requires that a meal which includes a toy must be below a certain calorie limit and provide a particular threshold of fruits and vegetables, among other conditions. Proponents of the law argue that these toys are marketed to kids to entice them into purchasing unhealthy meals (or to put it more accurately, into begging their parents to buy them unhealthy meals.)

I actually do believe that fast food is a significant contributor to the obesity epidemic in this country. I am all in favor of healthier menu options, and I think parents should be careful to provide their children with a healthy, well-balance diet.

But the truth is, ever since the invention of sugar and trans fats, kids have been begging their parents to buy unhealthy foods. I used to eat Snickers ice cream bars at my friend's houses, cookies at my aunt's house, Fruit by the Foot at my grandma's house, and sugar cereal at the houses of those for whom I babysat. But when I went to the grocery store with my parents, did they then feel obligated to purchase sweets and fatty snacks at my every whim? Absolutely not! Why? My parents were the parents of our household, and while they allowed me to indulge in the occasional treat with a friend or family member, they knew the power of "no!"

I understand why we ban advertisements that make dangerous substances look cool to teenagers. Teenagers sometimes have cars, jobs, and a fair amount of freedom. So I am totally on board with banning cigarette advertisements aimed at young people, who are legally too young to consume them, but may have the will and the means to buy them.

Happy Meal toys, on the other hand, are typically designed for very young children. The last time I checked, six-year-olds don't have cars, jobs, or any significant freedoms. So whether or not McDonald's advertises a free toy on television, I am pretty sure it is parents who are driving their kids to McDonald's, forking over the money, and acquiescing to their child's desires.

My parents were not scrooges. They occasionally took us to McDonald's growing up, mainly when we were on a road trip, and sometimes just as a special treat. And we were allowed to have desserts on weekends or, as mentioned above, at another family's house. But my sister and I understood not to even ask most other days, because we already knew what the answer would be. No. The same answer my parents would give when we asked for quarters to play every game in a store. The same answer my parents would give when we asked to buy a toy when it was not our birthday. The same answer my parents would give when we asked to sleep over at a friend's house with no parental supervision.

Despite the television commercials, peer pressure, flashy signs, and twinkling music that constantly bombarded our family, my parents were able to use their discretion to say no.

In my opinion, mandating what a restaurant should and should not serve, beyond what is considered safe for consumption by the FDA, crosses the line in overbearing governance. If you don't want to eat the food, don't go there! There are plenty of other choices. California chain restaurants are already required to post the calorie counts of their offerings, and after that, consumers make their own decisions.

It seems to me that if parents are not already using common sense to moderate the amount of fast food their children consume, taking away the free toy is not going to change much. It is parents who drive the vehicles, earn the money, and ultimately make the choices. And it is parents who must ultimately take responsibility for the willpower to say no.

If the lure of a cheap trinket is enough to sway parents away from consistently doing what is best for their children, I don't think the trinket is really the issue.

Oh, and I wouldn't want to neglect mentioning the best part!

The outcome of all this law-making nonsense? The San Francisco McDonalds' now charge 10 cents to customers who want to purchase the toy separately, with all proceeds going to the Ronald McDonald House charity.

Photo credit:

Friday, January 27, 2012

Jamie Oliver's Food Revolution Lives On!

Since I mentioned Jamie Oliver briefly in my last post, I thought it would be a good idea to explain. Basically, he is a spunky English dude who had a great show on ABC called "Jamie Oliver's Food Revolution." I am sad to see that the show is no longer on the ABC website, as it was one of my favorites.

The basic premise was that in order to fight the obesity epidemic, Jamie wanted to change the minds of Americans about how to cook fresh, healthy, and delicious food. For the television show, he went into public schools to reveal the junk being served and to re-teach the cafeteria workers to cook using fresh, healthy ingredients. In addition, he engaged the community by opening a kitchen that offered free healthy cooking classes, holding public demonstrations, hosting cooking competitions, and more. (He is also the one who first alerted me to how much sugar is in a typical serving of chocolate milk. It is truly astounding!)

In the first season, Jamie tackled the town of Huntington, West Virginia, dubbed the "fattest city in America." I was surprised by how much resistance he met along the way, not just from the school board, but also from families who opted to send their kids with home-made lunches after they saw the healthy changes Jamie had made in the cafeterias. Why parents would allow their children to buy pizza and french fries every day, but then actively switch to home-packed lunches once healthier options were implemented, just defies explanation. Jamie even created the recipes specifically with kids in mind, such as healthier nachos. It wasn't as if the schools were serving bland, boring meals.

One day, after he had begun making changes to the school lunch menu, he did a survey of the home-packed lunches in the cafeteria. He found only one child with a sandwich and fruit. Most of the rest, whose parents had recently decided to disallow the purchase of the healthier school lunches, did not even have what I would consider a "main meal item," but had brought only chips, candy, and juice boxes or sodas. That just shocked me, as I had never encountered a friend growing up whose parents did not even try to provide a single healthy item - imagine encountering an entire cafeteria of these lunches!

In the end, I suppose parents have the right to decide what their kids eat for lunch. If parents want to send their kids into the cafeteria with only junk, well, I guess it is their prerogative to expedite the onset of type two diabetes. I am not categorically criticizing parents who either pack a lunch or who allow their children to purchase a school lunch. My own family usually did the school lunch thing growing up, and I turned out just fine. (Although after watching the show and reading a bit, I have a feeling my school district was doing a bit better than most with the lunch options.) My husband's family, on the other hand, always hand-packed a nutritious meal. Kudos for the extra effort and saving money! But what I really don't understand is if you were already sending your kid to school with $2.00 per day to purchase a bunch of cheap, greasy, over-processed food, why would you change your mind once the food had improved with no extra effort or cost on your part? Kids tastes will evolve if they are exposed to good things!

Finally, after months of work, Jamie seemed to make some progress in changing the minds of Huntington's residents and getting parents on board with the improvements he was implementing. I would be interested to see how the town is doing now.

Jamie was met with even more resistance in Los Angeles during the show's second season, mainly due to a ridiculously paranoid school board. Most people would gag to see the stuff they serve in school lunches there. Whereas Huntington's typical fare was only moderately worse than the school lunches I grew up with, Los Angeles' food is pre-made at a central location, packaged as individual servings in plastic wrap, frozen, and then microwaved/served in said plastic wrap at the schools. Every single item looked like a soggy, plastic-y mess. Gross! Alas, I can understand the stern interventions of that school board - if I were them, I would not want my disgusting food secrets exposed either! Sadly, that may have been the demise of Jamie's television show.

Although his show is no longer on the air, Jamie still maintains a very informative website, with facts about what America eats, what we serve in our school lunches, and how you can help bring about change. And of course, he has some very easy recipes to try in your own home!

One recent and interesting development in the school lunch/breakfast saga is the passage of the new USDA nutritional standards, which were released this month as part of the Healthy, Hunger-Free Kids Act. This act was spearheaded by First Lady Michelle Obama and initially signed into law in late 2010.

Although it is true that the nutritional standards still allow the serving of french fries every day and consider 2 TBSP pizza sauce a "vegetable," (you can thank special interest groups for lobbying to keep these wonderful rules), the legislation is a major improvement over what has been in place for the last fifteen years. It requires less sodium and trans fat, while mandating more whole grains and fruits/vegetables. Some of these changes will be phased in over several years, with intermediate targets that schools must achieve.

For example schools are expected to meet certain sodium targets for each week of meals, which represent a 25% - 50% reduction in sodium content for breakfasts and lunches. According to the USDA/Department of Agriculture report, for ages 4-18, the upper limit for sodium intake ranges from 1900 to 2300 milligrams per day. Schools are expected to meet certain intermediate targets to be checked at the two year and four year marks, achieving full compliance (averaging below the maximum daily intake recommendations) in ten years.

Many schools systems are concerned about meeting the various nutritional targets while staying within budget. While I acknowledge that this is a genuine obstacle, I tend to lean towards the stance that they should stop making excuses for contributing to the obesity epidemic and get busy creating new menus! I bet Jamie Oliver would be happy to point them to some excellent resources and recipes. And in the Bay Area, I am sure we can harness some of our innovation power to overcome these real challenges in a way that meaningfully improves our communities. Ten years should be sufficient time to plan.

Most importantly, I sincerely hope these new regulations make a real difference in the health of our nation's children!

If you want to learn more about Jamie Oliver's Food Revolution, check out his website!

I also highly recommend reading the full summary of the new nutritional standards.

Photo Credits:

Thursday, January 26, 2012

Milk on the Mind

I have never been a calorie counter. This is probably in part because I was very thin throughout my childhood and even had trouble putting on weight when I wanted to. Those days are gone, but I never picked up the habit of counting my daily intake. In general, I believe in consuming a balance of healthy foods, with an occasional treat, and getting moderate exercise. I do check the labels of most processed foods before I purchase (for example, comparing sodium, overall calories, and calories from fat between two cans of soup before buying), but I don’t really go crazy about this sort of stuff. If I put on any significant amount of weight, I figure my food balance or my exercise is a little off, and I make a tweak.

So imagine my surprise recently when I actually put a number to the difference in calories between types of milk. After seeing that Lucerne brand skim milk has 40 fewer calories than 1%, I decided it was worth the switch. I drink about one glass per day with dinner, and occasionally, I have milk with my breakfast cereal. So I figured I would be saving at least 280 calories per week, likely more, for pouring my milk out of a different colored container.

I was hesitant at first, because I have tried those brands that taste more like milky sugar water, and I can understand how that would turn someone off from skim milk. But if you do make the switch to a lower fat milk and don’t like the taste, just give another brand a chance! I feel so thankful that most of the brands in our supermarket have full flavor, which is nearly indistinguishable from 1% to skim.

So now for the numbers…

From the milk containers in our refrigerator and from online searches, it looks like an 8 oz glass of Lucerne brand milk has 90 calories in skim, 130 calories in 1%, 130 calories in 2% (but more calories from fat there), and 160 calories in whole milk.

My favorite comparison for anything is a can of Coca Cola. I love Coca Cola (or Pepsi, any cola really), and I despise the nasty flavor of diet soda. But I have heard the lectures about how much weight people put on just from drinking soda, so I limit myself to one per week or fewer. When I am deciding whether a candy bar is worth it or not, or how many snacks I should put in a bowl, I think about it in terms of how make Cokes I could consume for the same number of calories. I call this the “Coke comparison rule of thumb.”

To put milk in perspective, consider that a 12 oz can of Coke in the United States contains 140 calories. That’s right, cola contains about the same number of calories as an 8 oz glass of 1% milk and fewer calories than a comparable glass of whole milk! Using my Coke rule, it turns out that switching to one glass of skim milk per day instead of one glass of 1% milk is the equivalent of two fewer Coca Cola’s per week. That was enough to convince me!

Now to be clear, I am not telling you to avoid milk! Milk contains protein, vitamins, and minerals, so the calories you consume from milk do a lot more for your body than the non-nutrient-filled calories you get from a Coke. Some doctors will even tell you that drinking low fat milk can help you lose weight. (I will neither espouse nor dispute this belief, as I am not a physician, but hey, you can Google it if you’re curious.) All I am really trying to say is that the Coke rule is an interesting comparison to keep in mind when you decide what type of milk is right for you and your family.

I would like to conclude with one final point that might surprise you. (This is for you, Jamie Oliver!) Many people are concerned about soda and chips sold in school vending machines. But did you know that the typical carton of chocolate milk, like those sold in public schools, contains around 225 calories per serving? (Think of the “Coke comparison rule of thumb” = 140 Calories.) Yikes!

Photo credit:

Tuesday, January 24, 2012

Innovation, Stress, and the Bay Area

According to the Mayo Clinic, persistent stress puts an individual at higher risk for heart disease, sleep problems, digestive issues, depression, obesity, memory impairment, and worsening skin conditions. The American Institute of Stress (AIS) also states, "Numerous surveys and studies confirm that occupational pressures and fears are far and away the leading source of stress for American adults and that these have steadily increased over the past few decades." There is a plethora of research indicating that job stress contributes to higher prevalence of chronic diseases and negative health outcomes. (I would like to do more research on this in future.)

In addition, AIS reports that the financial cost of job stress in this country alone is estimated to be over $300 billion per year in accidents, absenteeism, employee turnover, diminished productivity, direct medical, legal, and insurance costs, workers compensation awards, etc.

Given this information, the San Francisco Bay Area ought to be on alert! We have job stress galore.

In order to give context to the major stressors here, I thought it would help to provide a little background on the vibe of the area. I have had several conversations with friends lately regarding the culture of the San Francisco Bay Area. And as it turns out, I am not the only one who has observed that this area has a very particular focus and pace of life. In just a year and a half here, I have come to understand the buzz words that make a person fit in and feel important. Innovation, entrepreneurial spirit, and startup mentality are a few phrases that come to mind immediately. (Note: If anyone is looking to move here, these are must-have key terms for your resume.)

Google, Facebook, Twitter, Yahoo, LinkedIn, HP, Sun Microsystems, Cisco, Oracle, Intel, Genentech, Apple, and Adobe all employ many Bay Area residents, just to name a handful of the myriad companies located in Silicon Valley. The area seems to be constantly abuzz with new ideas, computer engineers, and the constant promise of the “next big thing” in technology.

In the Wall Street Journal’s list of the top 50 venture backed companies (startups) of 2011, thirty of the fifty companies were located in the Bay Area, and seven of the top ten hailed from this region. The list did not even allow for the inclusion of such larger and well-known companies as Facebook and Twitter, as the ranking included only startups valued below $1 billion. I have no doubt our region would make the top of the list in larger startups, as well. The disproportionate number of new businesses in this area is indicative of the driving culture, which in my opinion, is mainly characterized by an obsession with new developments and innovation.

Although the spirit of innovation has driven many important technological advances, one cannot help but wonder about the immense pressure this culture puts on individuals who live and work here. Are we hurting our community more than helping it by contributing to so much stress? What sort of impact are the typical Bay Area mantras having on our emotional health and well being?

For one real life example, consider the Bay Area seminar about “branding yourself” that one of my friends recently attended. It was meant to teach individuals how to market themselves for networking, searching for a job, or starting a business. Her major takeaway was that if you want to market yourself in pretty much any way, you must be constantly on your toes, upbeat, and extremely enthusiastic about what you bring to the table, because every interaction is a marketing opportunity. If you want to market yourself as a fashionable person, for example, you must always leave the house dressed very fashionably. That seems like straightforward advice on the surface, but consider the sheer amount of energy it would take to be enthusiastic at all times, even among close friends, in order to market yourself to the fullest extent.

Her response was, “How about branding myself as honest? I am good at honesty.” In other words, Branding myself sounds exhausting and fake. Do I really have to pretend to be someone I am not in order to matter here?

This is not to say we should not be personable and enthusiastic when meeting new people or discussing our passions, but do we really need to pretend we have it all together all the time, when in reality, no person has it all figured out? This push to brand oneself in line with the particular culture of the area leaves a person convinced that her own interests and personality don't make the cut and stressed about how to conform to something that doesn't fit her core passions and values.

I also had a conversation with two female friends about women who want to work part time or stay at home. In some areas of the country, this is the norm, and women are even insulted for neglecting their families by taking a full time job. In the Bay Area, it seems that the choice to prioritize family in this manner is viewed as lazy or demonstrates a lack of drive to succeed. My one friend who is not employed feels like she has to hide the choice, even from family, as she is made to feel ashamed. The weight of this "shameful" burden is yet another stressor placed on many people in the Bay Area.

I would not condemn a woman for working full time, working part time, or staying at home, as I believe different individuals are called to different lifestyles at various stages of their lives. But even as a woman who already works full time, I have felt the pressure to constantly regurgitate the mentality that “my career is everything” in order to prove that I am driven. “My goal is to be CEO one day!” In reality, I do have the desire to gain increasing levels of responsibility, but I have no intention of working eighty hours a week as a high level executive. Yet that’s what the culture says I should project in order to be taken seriously, so I must engage in the stressful pursuit of maintaining that image through constant vigilance and masquerading.

Many Bay Area companies attempt to mask the pressures they place on employees by dressing up the workplace with food and games. This is an innovative way to disguise the obsession with long working hours and well, innovation itself. But let’s face it – Google offers free breakfast, lunch, and dinner to employees, because the higher-ups want workers to be there for all three meals. Anyone who thinks otherwise is fooling themselves. While it is easy for many to condemn the "workaholic" attitudes of individuals whose jobs are part of the typical corporate rate race (read: Wall Street), we somehow cast the pursuit of innovation as a much nobler undertaking. Nevermind that technology companies are still out to make money; they are seeking a greater glory, and this type of bondage to one's job is different. This "superior work ethic" is all considered part and parcel with innovation, entrepreneurial spirit, and the startup mentality of this region.

I work to make changes to inefficient processes at my job. I identify extra projects that will make our company better. I pay attention to details and try to anticipate the needs of those for whom I consult. I stay late to support my colleagues when the work load requires (as evidenced by my 11pm evenings during some of our negotiations last year). But I will go home at a reasonable hour when I am able, because I care more about investing in my marriage than I do about investing in my company. There, I said it. (And now I feel as though I have committed a Bay Area crime of words that precludes me from all future job opportunities.)

In my heart of hearts, I know that it cannot be true that everyone I meet has an “entrepreneurial spirit,” yet that’s what we’re all selling.

Is it so wrong to say that I am smart, I work hard, and I am passionate about something, but I have no intention of starting my own business in the near future? If I were to start a business, it would be because I saw a great need in the community and felt compelled to fill it, not because I have a wild heart that can only be fulfilled by making my own rules and dedicating my life to my work. On the other hand, so many people in this area seem to decide they want to be a leader of a startup and then begin scraping around for an idea. This mentality has been called “the startup bug,” and those who catch it have high hopes of achieving the glory that comes with founding the next big money-maker, whether or not their vision would really better the world around them. (This is not to say every startup is conceived in this manner, but this concept appears to be much more pervasive in the Bay Area, as supported by the sheer number of startups here, including those on the Wall Street Journal’s list of top 50 startups.)

Ultimately, I think we are often peddling innovation for the sake of innovation itself, rather than seeking unique solutions to important problems that really matter to society. The cost of this push on individual stress levels, personal relationships, and general quality of life is secondary to the business results achieved.

I believe this mentality is ultimately devastating to the long-term health of individuals and the health of the community. It measures everyone against a standard that only make sense for some and suggests that the particular “standard” is the end-all-be-all of personal worth. This leads to a constant competition for each individual to appear the most enthusiastic about the concept of innovation or the startup mentality. It inherently undervalues individuals who view success in different terms than the norm of the technological culture or who contribute through means other than entrepreneurship (such as volunteerism or supporting a family in the home).

For individuals, this means added personal stress and the increased risk of chronic illness or declining relationships. For a community, it may mean belittling critical members who fill crucial, but under-recognized roles.

I believe that innovation is critical to societal progress. One just has to look at all of the life-saving medicines that have been produced in the past century to see a prime example of innovation changing the world. Likewise, I think those who feel the innate desire to start a company should go for it!

But I do not believe that every person should be brainwashed or boxed into thinking that technological or entrepreneurial achievement is the only way to matter or to stand out.

I believe that God created each person uniquely, loves us individually, and has a plan and a purpose for our lives.

Psalm 139:13-16

For you created my inmost being;
you knit me together in my mother’s womb.
I praise you because I am fearfully and wonderfully made;
your works are wonderful,
I know that full well.
My frame was not hidden from you
when I was made in the secret place.
When I was woven together in the depths of the earth,
your eyes saw my unformed body.
All the days ordained for me
were written in your book
before one of them came to be.

I believe a healthy community is one that recognizes the inherent worth of every person.

Now that is an innovative idea worth fighting for!

Photo credits:

Sunday, January 22, 2012

23 1/2 Hours

My friend Stephanie posted a link to this health-related YouTube video on her facebook page. It's all about the best medicine money can buy.

I am still waiting for the day when a scientific study finally proves what I've known all along, which is that Doritos and chocolate are the real life-savers. But until that study goes public, I thought this video was very informative.

There's nothing quite like being convicted by YouTube.


Wednesday, January 18, 2012

Health Literacy...Say What?

One issue in health care that is rarely discussed in the public domain, but which deserves significant attention, is health literacy. Health literacy is not the same as the general ability to read and write, although it is often related. Health literacy specifically refers to an individual’s capacity to “obtain, process, and understand basic health information and services needed to make appropriate health decisions.” (Institute of Medicine 2004)

Health literacy comes into play whenever a person purchases or administers a medication, reads an article about a health topic, fills out an insurance form, or discusses treatment with a doctor. It can impact the way parents care for a sick child or how adult children manage the health care of an ailing parent. It influences how an individual selects insurance coverage or how a person without insurance makes health decisions. In fact, health literacy contributes to almost every aspect of a person’s interactions with their own health, the health of those around them, and the healthcare system.

In 2003, the National Center for Education Statistics (NCES) conducted the National Assessment of Adult Literacy (NAAL). In additional to measuring general population literacy, they included a health-specific section of tasks to test individuals’ abilities to understand health texts (such as pamphlets), to utilize health forms in various formats, and to complete basic health care computations. These areas of ability were used to create a health literacy scale with four levels of performance: Below Basic, Basic, Intermediate, or Proficient.

The results of the testing showed that 12% of adults were proficient, 53% were at the intermediate level, 22% had basic skills, and 14% had below basic health literacy.

The results varied by several demographics. For example, women had higher average health literacy than men. White and Asian/Pacific Islander adults had higher average health literacy than adults of other racial/ethnic groups. Hispanic adults had lower average health literacy than adults in any other racial/ethnic group. Adults over age 65 had lower health literacy, on average, than younger adults. Literacy level also varied based on socioeconomic status, native language, media/internet access, and insurance status.

In addition, the NAAL showed that health literacy varied widely with education level. Among adults who never completed high school, approximately 49% had below basic health literacy. By contrast, 15% of adults who ended their formal education with a high school diploma and 3% of adults with a bachelor’s degree had below basic health literacy.

The real importance of all this information is that, as one might expect, individuals with higher health literacy also self-reported better overall health.

When a woman struggles to understand directions from her physician, the chances of successfully managing a chronic illness are lower. When a man is unable to read a chart showing the healthy weight for his height and age, he may not realize he is moderately overweight and will be less likely to consider lifestyle changes. When a mother does not understand the dosage instructions for her child’s medication, she is less likely to foster a quick recovery and may even make a grave error. When a young man does not understand his insurance plan, he may not realize that he will pay significantly more to get a couple of stitches at the emergency room as compared to a local urgent care clinic.

Provider-patient interaction, disease prevention, and navigation of the health care system all contribute significantly to the health outcomes of individuals, as well as the cost of our overall health care system.

So how should we respond to these results about health literacy? What can be done to improve the health literacy of our population and to make navigation of the health care system more manageable?

One step that has already been taken by President Obama is the Plain Writing Act, which was signed into law on October 13. This act requires federal agencies to write all public documents in a “clear, concise, well-organized” manner. This includes Medicare and Medicaid forms! (Although I supposed "clear, concise, and well-organized" is mainly in the eyes of the writer.)

Many non-federal agencies, such as pharmaceutical and insurance companies, are also encouraging the use of plain language. This does not mean that the company “dumbs down” concepts, but that it uses common vocabulary and more streamlined structures of communication to state the same information.

Compare the following:

A. The Dietary Guidelines for Americans recommends a half hour or more of moderate physical activity on most days, preferably every day. The activity can include brisk walking, calisthenics, home care, gardening, moderate sports exercise, and dancing.

B. Do at least 30 minutes of exercise, like brisk walking, most days of the week.

Option B is clearly in plain language compared to option A, and they communicate the same essential point.

Another idea to improve health literacy is to incorporate additional skills into existing health education classes (such as those that cover sexual health in middle and high school.) These could include the basic skills of reading health-related articles, filling out health forms, understanding medication instructions, and learning basic insurance terms, like “deductible” and “copay.”

It may also be helpful to provide more extensive literature and/or classes for health care professionals on communicating with health literacy in mind. Since I am not a health care provider, I do not actually know what sort of training physicians, pharmacists, and other providers receive in this area already. It might even be helpful to train the secretary or office manager at the front desk of a doctors’ office.

Many hospitals and insurance companies may also benefit from amplifying the role of personal phone calls from nurses in following up with patients. A three minute call may reveal that a patient is not following post-operation instructions or has questions about medication side effects that can be answered right away, which may or may not have come up before the patient returned home. This sort of pro-active approach offers a patient the opportunity to get further clarification on any instructions or ideas they did not understand originally. And it can prevent unnecessary complications or readmissions to the hospital.

Some communities already have nonprofit organizations, which help individuals navigate the health care system, particularly the application processes for Medicare and Medicaid. If the government, doctors, hospitals, and insurance companies collaborated with these organizations, they could potentially support classes that introduce members to basic health literacy concepts. Or they could more generally glean information from the nonprofit’s experience about the most common areas of difficulty and use the information to make document and process changes.

I am very interested to know if others have ideas that they think would improve health literacy or that would make the health care system easier to navigate. Please share!

Photo Credits:

Tuesday, January 17, 2012

Thoughts From My Adult Brain

Last month, Gene Marks published a piece on, "If I Was a Poor Black Kid." The improper grammar of his title aside (“were,” not “was”), this article was truly an insult to journalism.

I would definitely encourage you to check out the links at the bottom of this post for some intelligent and humorous responses by those who would agree with my general repulsion.

I will not go into too many details on my myriad complaints, but suffice it to say that my husband endured hours (literally) of my ranting about Marks’ drastic oversimplification of such a complex topic, from ignoring hundreds of years of history, to making poverty into an issue of money alone, to employing a paternalistic tone. But on top of all that, his article left readers asking,

Has Gene Marks ever met a kid? (A real, live kid?)

Ok, so apparently he has, since he talks about his own children in the article itself. But that teeny weeny fact aside, I am still convinced he has not spent time discussing anything of importance with children, given that he appears to think they are making detailed life plans at the age of three (ok, maybe ten).

What does this have to do with the health of the mind and body?

Well, I thought this would be a perfect opportunity to introduce a few tidbits of information about childhood cognitive development. This is a topic of particular interest to me, and I will certainly bring this up again in future posts, with more detail.

For many people who have, in fact, interacted with children, it seems like common sense to say that the brain of a child just doesn’t process information and react to situations like that of an adult. And the reality is that the science supports your hunch.

When your two-year-old is hungry and throwing a fit in the mall, you don’t expect him to weigh the ethical implications of his tantrum and the impact it has on others. Why? You can intuit that his brain is not capable.

And it’s not just two-year-olds. You may wonder why your teenager doesn’t recognize the wisdom in your advice when you just want what is best for her. Guess what? The teenage brain is still developing, too, and it actually weighs the risks, rewards, and consequences of actions differently than an adult brain. (To learn about one reason, read “Why Teens are Wired for Risk.")

This is not to say that kids do not have the ability to impress us with their intellect and maturity. Many children have superb reasoning capabilities, a wide range of talents, and generally sound decision-making skills. But even so, it is still true that the various parts of the brain that control our social interactions and even our moral decisions, normally develop at certain ages, and these developments play a significant role in childhood behavior.

I must preface the remainder of this post by saying that I did not major in psychology, child development, or neuroscience. I am not a child care professional, nor am I a teacher. But one introductory psychology course and thirty hours of training to be a Court Appointed Special Advocate (CASA) for abused youth have provided me with enough knowledge to believe that Gene Marks has the wrong ideas about how a child really thinks. (It does not take much knowledge to lead a person to that conclusion.)

So here is my attempt at a very brief summary of “how children normally develop” at different ages, starting with pre-school. (The earlier years are also crucial to childhood development, so I will try to cover those another day, but I didn’t want this post to get any longer than it already is.) The age ranges I am using here are very broadly grouped, as this is meant to be a laconic summary, not a comprehensive one. Special thanks to the CASA program for much of the information:

  • Preschooler: Learns to distinguish between fantasy and reality; solves simple problems; becomes comfortable with feelings, thoughts, and actions; requires the experience of expressing emotions and having others respond in order to develop normally.
  • School age child: Continues to develop distinction between reality and fantasy; develops greater distinctions between feelings, thoughts and actions; grows problem solving skills; gains a sense of accomplishment around learning and applying skills, handling peer relationships, and self control; begins to develop and test values and beliefs.
  • Early teen: Begins coming to terms with dramatic physical changes (starting puberty); increases concern about appearance; continues to develop values and beliefs; challenges adult logic and begins to strive for independence; knows right and wrong, and tries to weigh decisions alone.
  • Later teen: Develops greater sense of self by integrating values, relationships, ideas about the future, and the world around them; continues to grow beliefs and values; moves towards independence.

These general guidelines help to determine if a child is “normal” in their development or lagging behind the curve. It is also important to realize that children who do not receive proper attention and care, or who undergo any sort of trauma at a given phase of development, will likely be developmentally delayed in the skills or behaviors that were meant to be achieved in that stage of growth. Trauma and neglect actually leave gaps in cognitive development.

This very brief list of “normal” developmental activity can also help us evaluate the soundness of Gene Marks’ ideas.

In his article, Gene Marks suggests that if he were a "poor black kid," he would spend his middle school years (think: twelve-years-old/early teen) attaining stellar grades through the use of technology, while saving his spare time to independently research private high schools, personally contact the admissions officers at said schools, fill out the applications, and apply for financial aid to fund his private high school education. This is all because for years, he would have had his mind on going to college and getting the best job possible after high school. He would desire to overcome the circumstances of his poor parents. So of course, as a twelve-year-old, he would be doing everything in his power to go to the best high school around.

Unfortunately for Mr. Marks, that sort of forward thinking and integration of ideas about the future mainly starts in the later teenage years, not in the typical twelve year old brain. Twelve-year-olds are only in the early stages of intellectually challenging adult logic and creating their own values. This means it is unlikely that a young boy is well along the road to "taking life into his own hands," diverging from his parents and peers to forge a brighter future (at least not intentionally.)

For further consideration, I will put the knowledge of developmental stages and the identity of the particular child in question aside, and I will simply recall what I was like at that age and beyond.

I am almost embarrassed to admit that as an “A” student applying to colleges at the end of high school, my dad did most of the work to gather a list of potential universities, including detailed information about each and every one, from average SAT scores to average snowfall. My mom filled out all of the financial aid applications. (She did not want me accessing all of their personal financial information, because my parents’ salaries and assets were none of my business – not that I could have read their tax returns anyway). I had to create a resume, fill out the college applications, and write the essays, yes, but even as a very ambitious and relatively mature “late teen,” I was not exactly marching into the future solo.

Jumping back four to five years to middle school, I was getting good grades and participating in the community, true. But I was not plotting my high school rise to academic stardom and researching prestigious institutions. I was figuring out what was important to me, learning to maintain peer relationships (i.e. ogling at boys), and generally having fun.

I encourage you to recall your own early teen years, and perhaps you, too, will wonder what was Gene Marks thinking? Maybe he was not aware that young children – even teenagers – of any race or socioeconomic status, are physiologically different from a grown man and simply do not have the physical, social, emotional, or moral brain development of a forty-year-old white guy.

I will always encourage kids to dream big, try hard, and push boundaries. But I will not expect my future children or the kids I mentor to take charge of their lives in a manner which is completely disconnected from their cognitive development.

My piece of advice to Mr. Marks: For everyone's sake, please use your adult brain before sharing future pearls of wisdom.

For interesting, intelligent, and funny responses to Gene Marks' article, see the following:


Monday, January 16, 2012

Colorful Eating

I was thinking about where to begin this blog, and I keep coming back to a subject that has been fascinating me for months: the benefits of eating a variety of colorful fruits and vegetables. I realize this is not exactly the weighty sort of topic that gets your blood pounding. But ever since I saw a presentation on this theme at work, I have been making different choices at the grocery store, and I think the information is worth sharing.

Different colors of fruits and vegetables contain unique nutrients and chemicals that aid in body function and health. Specifically, colorful veggies contain a variety of phytonutrients (or phytochemicals).
According to the USDA website, phytonutrients are “organic components of plants…thought to promote human health… Unlike traditional nutrients (protein, fat, vitamins, minerals), phytonutrients are not ‘essential’ for life, so some people prefer the term ‘phytochemical.’”
Although these chemicals are not “essential” for day to day life, there is a plethora of research indicating that these agents play a significant role in the prevention of disease. Phytonutrients are believed to serve as antioxidants, improve the immune response, and/or detoxify carcinogens (harmful cancer-causing toxins), among other things. Some studies have even linked them to killing cancer cells or repairing DNA damaged by smoking.
For example, a study published in 2007 by the American Society for Nutrition (from UMass-Dartmouth) suggests that the phytonutrients in cranberries (ployphenols and flavenols) inhibit the growth of breast, colon, prostate, lung, and other tumors.
The Brazilian Journal of Microbiology published a study showing that extracts from clove, jambolin, thyme, and pomegranate plants were able to combat antiobiotic-resistant bacteria in a laboratory.

Now back to the point – COLORS.
These chemicals are frequently associated with specific pigments in the foods you eat.
Flavanoids (polyphenols), which are known for their strong antioxidant, anti-allergenic, and anti-inflammatory mechanisms, are typically linked to red, blue, and purple pigments, such as those found in strawberries, cranberries, grapes, and black-eyed peas.
Carotenoids (tetraterpenoids), which have been shown to improve the immune system and engage in antioxidant activity, are usually found in plants with orange pigments, such as carrots, pumpkins, oranges, tomatoes, guavas, and sweet potatoes. Beta carotene is a well-known carotenoid that aids our ability to see at night.

And these are only a few examples in the long list of phytonutrients.
These color associations are not necessarily exclusive. For example, dark leafy greens also contain carotenoids, and “greens” are obviously not orange. But the colors are a helpful way to gauge whether or not you are getting a wide variety of phytonutrients in your diet.
Nowadays, when I make a salad, I make sure to use lettuce with a nice dark green or purple hue, and I add splashes of color, such as red peppers, white mushrooms, purple beets, or blueberries. Or when I make a casserole, I try to vary the vegetable colors, with yellow squash, green beans, or orange carrots. (Better yet, did you know that carrots also come in white, yellow, and purple, as well? Check your local farmers market!)
And this colorful practice has the added benefit of making my food more pleasing to the eye.
If nothing else, remember that the color of a fruit or vegetable is usually a primary indicator of the chemicals within. Eating a wider variety of colors helps you pack more health benefits into a single meal!

For more information, see the following links:
Photo Credits: