Am I stoned?



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Solutions

  • Restructure tax system
    • Increase capital gains tax from 15% to (at least) prior 25% rate
    • Resume transaction tax on stock sales/purchases (1/2 of U.S. stock market activity = computer-assisted “microtrades”
    • Increase taxes on destructive activities (e.g., carbon emissions, toxic waste generation)

Solutions

  • Create progressive state taxation systems (all currently regressive)
  • Greater regulation of financial markets
  • Eliminate confidential legal settlements and confidential business information relevant to public health and safety
  • Eliminate binding mandatory arbitration

Solutions

  • Stronger clean air and water standards
  • Further revise and update TSCA
  • Pass SB 7-14 (to phase out top 22 persistent, bioaccummulative, and toxic chemicals – e.g., asbestos, brominated flame retardants, Cd, Hg, Pb, others)

Solutions

  • Drink tap water
    • Incredibly cheap and, in the US, almost always safe
      • Exceptions include private well water, from which 15% of Americans get their drinking water
        • Not regulated by Safe Drinking Water Act
        • 40% contaminated to some degree with arsenic, radon, nitrates

Solutions

  • Eat less meat
    • It takes 12-16 lbs of grain and 2500 gallons of water to produce one lb of hamburger
    • Avg. American adult consumed 198 lbs of meat in 2014 (global avg. = 75 lbs)
  • Catch-share agreements to decrease over-fishing

Solutions

  • Eliminate fossil fuel industry tax breaks and subsidies
  • Carpooling
  • Keep car longer
    • > ½ of energy consumption attributable to vehicles occurs during manufacturing

Solutions

  • Sweden plans to be world’s first oil-free economy by 2020
  • EU to cut CO2 emissions 20% by 2020
    • UK committed to 80% reduction by 2050
  • California mandates 25% cut in global warming gasses by 2020

Solutions

  • EPA to regulate carbon emissions under Clean Air Act (2011)
  • 2016 Paris Climate Agreement to limit global warming to 1.5 degrees above pre-industrial levels
  • 2017: Kelsey Cascadia Rose Juliana et al. v. USA et al.
    • Federal lawsuit brought by young people under public trust doctrine accusing government of violating its duty to protect future generations from climate change

Solutions

  • Climate Security Act: weaknesses include unfair “cap and trade” provisions, carbon capture and storage (CCS)
    • Cap and trade for water in Australia, proposed for American West
  • New EPA rules re mercury, coal ash (2011)
  • New EPA rules to reduce methane emissions from oil and gas drilling

Solutions

  • Replace annual crops with perennials
    • Sequesters CO2
  • Support organic farming
    • converts carbon from a greenhouse gas into a food-producing asset

Solutions

  • Solar and wind power (prices decreasing dramatically); appropriate biofuels (i.e., cellulosic ethanol, algal bio-diesel; not food crops), not CCS (carbon capture and storage) or nuclear
    • CCS raises specter of Lake Chad, Lake Nyos, and Lake Monoun disasters
      • Implies dangers likely to be associated with carbon capture and storage

Solutions

  • Increase tax breaks, subsidies, research for renewable energy
    • Renewable energy now 3% of transportation fuel market (ethanol) and 9% of the electricity market (wind, solar, biomass)

Thomas Edison (1931)

  • “I’d put my money on the sun and solare energy. What a source of power! I hope we don’t have to wait until oil and coal run out before we tackle that”

Solutions

  • Streamline EPA -25% of 14 billion superfund payouts have gone to lawyers and consultants
  • Composting / Recycling organic wastes
  • Safe disposal of pharmaceuticals
    • Europe, Canada have take-back systems
  • Shift medical research agenda

Solutions

  • Decrease light pollution ($2 billion energy wasted per year) and see the stars!
    • 2/3 of US population and over ½ of EU population can’t see Milky Way
  • - Czechoslovakian anti-light pollution law
  • - light pollution also adversely affects some ecosystems

Solutions

  • Insulation
  • Energy-efficient lighting
    • Europe bans incandescent lightbulbs (2009)
    • Australia mandates use of compact fluorescent light bulbs by 2012
    • US manufacturers to phase out traditional lightbulbs in favor of compact fluorescent bulbs (contain mercury) and very long-lasting LED bulbs by 2104

Solutions

  • Decrease excessive packaging
    • ¼ of world lives with ban or fee on plastic bags
    • 15¢/plastic bag tax in Ireland ↓’d use by 90%, England now charging 5p/bag
    • More than 30 states have enacted or proposed plastic bag restrictions

Solutions

  • Decrease excessive packaging
    • CA, Seattle, Chicago, Portland (OR), Austin, Mexico City have outlawed plastic bags
    • Canada, China, Italy, Bangladesh, and a few other countries have banned; others considering ban
    • Charge for paper bags (LA) – markedly decreased use
    • France has banned all plastic cups, plates, and silverware (law takes effect in 2020)

Solutions

  • Sustainable forest management
  • Plant trees
    • The average urban tree removes nearly one ton of greenhouse gas during its first 40 years of life
  • Stop receiving catalogues
    • contact Direct Marketing Association

Solutions

  • Prevent Congress from weakening NEPA (National Environmental Policy Act)
    • Requires federal officials to conduct environmental impact assessments; allows citizens to challenge the government’s conclusions

Solutions

  • Change or eliminate Office of Information and Regulatory Affairs
    • White House Dept. which operates in relative secrecy and has power to rework various federal agencies’ (e.g., EPA, FDA, OSHA) rules and delay new regulations

Solutions

  • Oppose Congressional attempts to create “Sunset Commissions” with the power to review federal programs and recommend which programs live, die, or get realigned

Solutions

  • Punish environmental scofflaws with large fines and jail time
  • Increase enforcement budgets to combat international environmental crime
  • Establish International Court of the Environment
  • Alien Tort Claims Act designed to hold corporations accountable for human rights abuses overseas

Solutions

  • Safe storage of nuclear wastes
  • Green electricity - $3/month
  • Bioprospecting
  • Ecotourism
  • De-extinction
  • Rewilding (Contemporary vs. Pleistocene)

Solutions

  • Green burial
    • Biodegradable, inexpensive “coffins”
    • Alkaline hydrolysis (85-90% fewer emissions than cremation)
    • Cremation – requires energy equivalent of 10-24 gals gasoline, avg C02 emissions 150 lbs, contributes 2-3% of US mercury emissions
    • Conventional burial with caskets, concrete vaults, toxic formaldehyde, and maintenance of cemetery lawns – most ecologically damaging
    • Consider donation of organs, entire body

Solutions

  • More equitable distribution of medical research funds and health care dollars
    • Worldwide
    • In U.S.
      • Every $1 invested in community-based programs to increase physical activity, improve nutrition, and prevent tobacco use saves $5.60 in health care costs

Address Social Factors Responsible for Illness and Death

  • Deaths in 2000 attributable to:
    • Low education: 245,000
    • Racial segregation: 176,000
    • Low social support: 162,000
    • Individual-level poverty: 133,000
    • AJPH 2011;101:1456-1465

Address Social Factors Responsible for Illness and Death

  • Deaths in 2000 attributable to:
    • Income inequality: 119,000 (population-attributable mortality – 5.1%)
    • Area-level poverty: 39,000 (population-attributable mortality – 1.7%)
    • AJPH 2011;101:1456-1465

Deaths per year

  • Tobacco = 400,000 (+ 50,000 ETS)
  • Obesity = 300,000
  • Alcohol = 100,000
  • Microbial agents = 90,000
  • Toxic agents = 60,000 (likely higher)
  • Firearms = 35,000
  • Sexual behaviors = 30,000
  • Motor vehicles = 25,000
  • Illicit drug use = 20,000

Address Social Factors Responsible for Illness and Death

  • Deaths in 2000 attributable to:
    • AMI – 193,000
    • CVD – 168,000
    • Lung CA – 156,000
    • AJPH 2011;101:1456-1465

Major Contributors to Illness and Death

  • 40% of US mortality due to tobacco, poor diet, physical inactivity, and misuse of alcohol
  • Every $1 invested in programs covering above items saves $5.60 in health care costs
    • Up to $1/$50 for tobacco control

Maldistribution of Wealth is Deadly

  • 880,000 deaths/yr in U.S. would be averted if the country had an income gap like Western European nations, with their stronger social safety nets

Prevention

  • 2-4% of national health care expenditures
  • Every $1 spent on building biking trails and walking paths would save nearly $3 in medical expenses
  • Every $1 spent on wellness programs, companies would save over $3 in medical costs and almost $3 in absenteeism costs

Public Health Spending

  • Public health spending minimal
  • Mortality rates fall 1-7% for every 10% increase in public health spending

Solutions

  • Reverse medical and scientific brain drain
  • Programs for education and return to home country
  • Eliminate unnecessary health care waste; re-use/send overseas hospital and surgical supplies
  • Open-access publication (see Dr Gavin Yamey’s slide show on the “Activism and Education” page of the phsj website

Solutions

  • Federal Research Public Access Act
    • Would require federal agencies that fund over $100 million in external research/yr to make their study results publicly available on-line
    • Currently before Congress

Solutions

  • Strengthen family planning programs
  • Decrease “demand” for large families
    •  education
    •  status of women
    •  child mortality

Solutions: Fair, Representative Elections

  • Publicly financed campaigns and campaign finance reform
    • Members of Congress spend between 30% and 70% of their time fundraising
    • 50% of Senators and 42% of Representatives become lobbyists after leaving office

Solutions: Fair, Representative Elections

  • Open debates, free air time for candidates
  • Proportional representation
  • Instant runoff (ranked choice) voting/cumulative voting/range (rating) voting
  • Halt disenfranchisement, overturn voter restriction laws

Solutions: Living Wage

  • Over 140 municipalities have adopted living wage laws
    • Including NY, LA, SFO, Seattle, Chicago, and Philadelphia
  • 25 states and DC now have minimum wages that exceed the federal requirement
  • 10 states have passed pre-emptive laws forbidding cities and counties from raising the minimum wage
  • True living wage at least $15/hr.

Solutions: Maximum Wage/Higher Taxes on the Rich

  • British-, French-, and New Zealand-proposed income-cap legislation (“maximum wage”)
  • France: 75% tax on income over 1 million euros

Solutions: Maximum Wage/Higher Taxes on the Rich

  • U.S. proposals to create maximum wage of $400,000 (president’s salary)
    • 25X annual pay of the lowest-paid federal worker
    • Patriot Corporations Act would cap pay at 100X pay of lowest paid worker

Solutions

  • Join and contribute to environmental and social justice groups (Greenpeace, Doctors without Borders)
    • Local grassroots groups especially good
  • Land purchases
  • Litigation (e.g., EJLDF, NRDC)

Solutions

  • Join community groups – become involved in local as well as national issues
  • Green investing -Returns as good or better than the S & P 500
  • Terror-free investing
  • Celebrities/Jocks for Justice

Solutions

  • Activism / Letter writing / Protesting / Whistleblowing
    • US Supreme court ruled in 2006 (Garcetti v. Ceballos) that public employees have no free-speech rights re whistleblowing and no constitutional protections against retaliation by bosses
    • Death toll among activists has doubled over last decade to 2/week
    • Over 900 environmentalists murdered worldwide between 2003 and 2013 (only 10 killers convicted); additional 116 killed in 2014
  • Copyright ©2010 American Public Health Association
  • Frieden, T. R. Am J Public Health 2010;100:590-595
  • The health impact pyramid
  • “Western science and efficiency has made major contributions to minor needs”
  • - Buddhist Monk, quoted in Wade Davis’ The Wayfarers

Solutions: Vote

  • US voter turnout low (139/172 worldwide)
    • Wealthy vote at almost twice rate of poor
    • Whites > Blacks > Hispanics
    • Old > Young
    • Property owners > Renters

Voter Turnout

Voter Turnout

  • Average senator = 62 yo
  • Average representative = 57 yo
  • Increased voter turnout by marginalized groups likely to lead to a younger, more progressive Congress
  • Limiting incumbency would also help (incumbents have a huge advantage in elections)

Solutions

  • Fair, representative elections
  • Campaign finance reform
  • Publicly financed campaigns
  • Better candidates
  • Lower voting age to 16

Solutions

  • Increased exposure to nature
  • Log off, spend less time in the virtual world, more time in the real world
  • Cultivate relationships

Solutions

  • Improvements in education
    • Multidisciplinary
      • Literature
      • History
      • Law
      • Photography
      • Community Service

The Role of Literature

  • Vicarious experience
  • Explore diverse philosophies
  • Promotes empathy, critical thinking, flexibility, non-dogmatism, self-knowledge
  • Encourages creative thinking
  • Allows for group discussion/debate

Why Use Literature

  • Encourage appreciation of non-medical literature
  • Develop reading, analytical, speaking and writing skills
  • Promote ethical thinking (narrative ethics)
  • Identification with authors who are health professionals (e.g., Keats, Chekhov, Maugham, Williams, Sanger, Nightingale, etc.)

Homelessness

  • Doris Lessing
  • “An Old Woman and Her Cat”
  • From the Doris Lessing Reader (New York: Knopf, 1988)

Race and Access to Care

  • Ernest J Gaines
  • “The Sky is Gray”
  • in Gray, Marion Secundy, ed. Trials,Tribulations, and Celebrations: African American Perspectives on Health, Illness, Aging and Loss. Yarmouth, Maine: Intercultural Press, 1992

Poverty

  • Orwell, George. How the Poor Die. In Sonia Orwell and Ian Angus, eds. The Collected Essays, Journalism and Letter of George Orwell, IV; In Front of Your Nose, 1945-1950. New York: Harcourt, Brace and World, Inc: pp.223-233.
  • Checkhov, Anton. Letter to AF Koni, January 26, 1891, Letter to AS Survivor, March 9, 1890. In Norman Cousins, ed. The Physician in Literature Philadelphia: WB Saunders, 1982.
  • Eighner, Lars. Phlebitis: At the Public Hospital. In Travels with Lizbeth. New York: St. Martin’s Press, 1993.

“Activist” Journals

  • American Journal of Public Health
  • Public Citizen’s Health Letter
  • PNHP Newsletter
  • Mother Jones
  • Harpers
  • Z Magazine
  • Hightower Lowdown
  • Synthesis/Regeneration

“Activist” Journals

  • Rachel’s Democracy and Health News
  • Rachel’s Precaution Reporter
  • Sierra
  • The Amicus Journal
  • Bulletin of Atomic Scientists
  • Multinational Monitor
  • Dollars and Sense
  • Some articles in NEJM, JAMA, JGIM, SSM, Policy, Politics, and Nurs Prac, others

Günter Grass

  • “The first job of a citizen is to keep your mouth open.”

Mahatma Gandhi

  • “You must be the change you wish to see in the world.”

Alice Walker

  • “The most common way people give up their power is by thinking they don’t have any”

Edward R Murrow

  • “A nation of sheep will beget a government of wolves”

Margaret Mead

  • “Never doubt that a small group of thoughtful, committed people can change the world. Indeed, it is the only thing that ever has."

African Proverb

  • If you think you are too small to have an impact, try going to bed with a mosquito in your tent

Contact Information and References

  • Public Health and Social Justice Website
  • http://www.phsj.org
  • martindonohoe@phsj.org


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