Tri-ing To Put it All Together

I’m a medical anthropologist by education, a public health policy “wonk” by trade and recently, among other things, I’ve added thinking-about-being-a -triathlete to my list of labels. I emphasize the “thinking about” aspect of this label as to date I’ve only competed in one triathlon and only have another two lined-up for this coming season. In just a year there is so much I have learned about this new sport and new “culture” and it has provided yet another lens to view my day-to-day work through.

As a swimmer “since birth” it’s not a huge surprise that I was drawn in my late 20s to triathlon. Some might say that having a strong background in swimming – swam competitively through graduate school – gives me an edge, since swimming is the weakest and most daunting leg for most triathletes. I’d beg to differ. Yes, I don’t really worry about my swimming and could complete 1500m practically in my sleep if I wanted to. But I know how much swimming can hurt, how your arms and lungs burn at the end of a race and how terrifying the anticipation of that feeling can be. Cycling is still a fun (if not slightly terrifying) novelty to me and running I’ve just gotten to the point of no longer hating. I am still relatively naïve to the sports of cycling and running, but swimming, swimming I know.

H&N Windsor swim

Having explicit knowledge and experience about one area of work and not others while working within a broader discipline is a common theme within my day-to-day in public health. I work with tobacco experts, nutrition experts, physical activity experts, global health and domestic health experts, economists, statisticians, etc. And I am somehow stuck in the middle of them all, combining all the various nuggets of evidence and experience to produce a coherent, multi-faceted outcome. It seems I work in one of the multi-sports of public health.

Like with triathlon, I’ve come to international public health policy with a background of experience in one particular sub-discipline – medical anthropology. And like with triathlon, I’ve had to work to gain both competency, confidence and endurance in a variety of new sub-disciplines and topic areas. I am comfortable with an anthropological framework yet know its limitations, like in the pool, and I’m slowly but surely (and sometimes awkwardly) gaining a working knowledge of those other areas. And then somehow, combining it all together into a single – hopefully successful – result.

There are a lot of things I like about triathlon… Its dynamic; it lends itself well to my over-organized tendencies; and it has been very welcoming and supportive of beginners to the sports.

There are, however, some aspects of the sport that I haven’t fully embraced… It is expensive – by no standard measure is triathlon an easily accessible sport (financially); there seem to be underlying themes around body image, weight and diet; and of course, the running.

I have evolving feelings about public health too and like with any multi-discipline endeavor, it’s all about balancing your strengths and weaknesses, often trying something new and then maybe, trying to piece it all together.

Image: Author’s own. Getting the season started with a swim – Windsor, UK. June 2013.

A Reminder (& 5 Extra Years)

For a while now I’ve been having what I think can only be called a mid-early-career/going-on-30-crisis. I’ve been very open about this with my family and friends and maybe not as open as I should be in the workplace. The gist of this “crisis” is that I’m not unhappy with my current situation, I just don’t know what I want to do when I grow-up. Day-to-day its hard to see what impact sitting at my desk is making to the world beyond and I can’t seem to shake the feeling that I can and should be doing more. But what?

From talking with friends and colleagues, I know I am not in a unique situation. A situation not helped by social media, global networks and surrounding ourselves with brilliant over-achievers. We are feeling like we have to achieve now, but achieve what I’m not quite sure.

And then this week, I saw something that reminded me – so simply – of one of the reasons I do what I do. And that being patient is OK.

It’s not revolutionary – and yes, a little sappy – but it makes the point. The point that there are big, complex public health challenges facing all of us and we have no choice but to believe that we need to and will make a positive difference for those that come after. I’m interested in NCDsHIV, my friends in Kenya, the built environment and all the messy, non-quantifiable stuff in between. I don’t know what I want to do when I grow-up and I probably never will, but that’s OK. I’m going to give myself 5 extra years (so to speak) to figure out where to go next. And hopefully from time to time I’ll stop to remind myself that what I’m doing now matters too.

Re-introduction to Syndemics

A review of a review…

Thanks to a trip to DC earlier this month to visit my parents, I was able to pick-up my copy of the December 2012 issue of Medical Anthropology Quarterly.

In addition to the expected interesting ethnography or two, I also found at the very end a book review of Merrill Singer‘s new text book – Introduction to Syndemics: A Critical Systems Approach to Public and Community Health. For those of you who don’t know, syndemics is a concept used (in public health, in anthropology) to explain the co-occurence of different infections or non-communicable diseases, the interactions of two (or more) diseases, and the association of poor health with social, cultural, economic and physical environment factors. Basically, its one word to describe my entire career.

Now commonly heard in public health, it’s used as short-hand to acknowledge the inter-play between biology and everything else. A concern I have with the term (as useful as it can be sometimes) is that it has become a catch-all for the complexity of populations’ health and the multi-dimensions of public health. Much like my hypothesis that culture has become public health’s placeholder for everything they don’t understand (or can’t  quantify) – but that’s a post for another day. I think the review is succinct and highlights the simple fact that disease burden is more complex than a series of biological agents in combination with SES. Social factors create the preconditions for syndemics AND inhibit their resolution. And to be perfectly blunt, the poor are shouldering the majority of the global disease burden with social factors that provide them with little to resolve this situation.

“…poor people living in poorly resourced and unstable environments carry the burden of communicable and noncommunicatble diseases and other health insults, which occur in individuals concurrently and that behave synergistically.” — Lenore Maderson,  reviewer

The classic syndemic is HIV/AIDS & TB – people with HIV are more likely to become infected with TB which in-turn leads to individuals who are more disposed to mental health problems and poor health care which further undermine their overall health. Presumably the book covers this extensively, partially because it is well documented. What Singer’s book is apparently missing, is dynamic investigations into the syndemics often overlooked by epidemiologists. For example, anemia and metabolic syndrome. Metabolic syndrome is of particular interest due to the rising global disease burden of NCDs. It offers the connectivity between obesity, stress, physical inactivity, food insecurity, poverty and so on.

Public health is syndemic and it is complicated. While this textbook is aimed at students, it seems those of us already working in public health would be done some good by re-introducing ourselves into the dimensions of syndemics and not be caught-out by the complexity of the challenges we face.

The More You Read

Phew, this is going to be up just in under the wire for my 2013 blog resolution..!

So, I read a lot about public health – at least more than the average person.  All sorts of things, like what’s going on with the Department of Health (for England) and front -of-pack food labeling; and what the alcohol industry is doing to campaign against the minimum unit pricing of alcohol (for the record, I support MUP); and the the quinoa debate (one perspective); and global discussions around non-communicable disease and sustainable development. To name a few.

There are studies, and evaluations, and news reports. And there are also reader comments. Little nuggets found following stories whenever a new, maybe controversial study or policy proposal comes out. For example, when anyone suggests the dutiful taxation of unhealthy food products. I find these comments fascinating – albeit infuriating at time – because while they clearly represent a self-selected section of the population, they provide a curious insight into what people think and how they perceive “evidence”. I’ve written before on perception vs. fact and how statistics and factoids can be misinterpreted and misrepresented by just about everyone, not just the media.

At work I’ve been having discussions around what evidence is? and can it be different to different stakeholders depending on their roles? And perhaps even more interesting, when is it OK to say enough is enough? Take obesity as an example of a topic which gets A LOT of press time (rightfully so) and just about everyone has an opinion on it and knows the “evidence”. Today, the New England Journal of Medicine put out a special article of the Myths, Presumptions, and Facts about Obesity. The basic thesis being that myths and presumptions regarding various aspects of the prevention and treatment of obesity exist – not just in the popular press – despite contradictory and/or missing evidence to support them. So why? And should the proverbial we be concerned? I don’t know.

I read a lot about public health. I read the modeling, and evaluations and case studies. But I also read the comments. Because they’re evidence too. The more you read, the more interesting stuff you find.

New Year’s Resolution(s)

I don’t generally believe in New Year’s resolutions. Well, I do not not believe in them, I just think people should be self-aware and striving to be kinder, healthier, what-have-you all year round. I do appreciate the symbolism of a new year, turning over a new leaf, starting fresh, etc. that January 1st brings however and for this situation I’m happy to embrace the tradition.

New Year'sSo. I’m making a New Year’s resolution for this blog — to actually post on it! 2012 was a busy and remarkable year for me and something had to give. Finally, sorta, kinda I have a new equilibrium and its time to start writing again. My resolution is to post no less than once a month.

And it’s not like there are a lack of interesting things to write about. The many potential resolution buzz boosters or killers circulating are enough for at least a month or two. Think – any drink is one drink too many; those a little overweight may have a lower mortality risk; and all the good stuff in the recent Global Burden of Disease report. Time to decided where to start.

Good luck to all of you who have made a resolution of two. Here’s to a healthy (and verbose) 2013!

Image: Thanks to Sommeecards for keeping us honest.