from 1776 to 2020-a vision for a “more perfect Union”

The United States’ healthcare system combines public health efforts with mostly private delivery of health care. Usually they coexist side by side with some but infrequent interaction. The public health emergency created by the pandemic forced them into a “union” that quickly became politicized, and unfortunately diminished the effectiveness of the response.

In ophthalmology, visual acuity is measured by the distance one can see compared to “normal”. A person with 20/80 vision can see at 20 feet what a normal vision person can see from 80 feet. Perfect vision is labeled 20/20.

Maybe you expected 2020 to be a perfect year. I doubt that any of us would say it was. The year brought

  • a contentious presidential election and an unexpected serious pandemic
  • peaceful protests and raucous riots
  • racism confrontations and reconciliation pursuits
  • health inequities battles and healthy community pursuits

This next year 2021 has already had its share of problems, but I think most of us feel calmer, more hopeful, and eager to resume many of the activites we put on hold last year. And that includes a 4th of July celebration.

Statue of Liberty
Lady Liberty lifting her torch in New York harbor
Independence Day, July 4

Every year on July 4th the United States celebrates Independence Day- the day in 1776 the original 13 American colonies established an independent country.

A few years later they established a government as specified in the Constitution of the United States, to “form a more perfect Union”.

The United States Constitution

The Constitution does not specifically mention, establish, create, or endorse a healthcare system. Some phrases in the Preamble hint at it though-

  • establish Justice
  • insure domestic Tranquility
  • provide for the common Defense
  • promote the general Welfare

Government sponsored health care programs

The Affordable Care Act, aka Obamacare

The  United States Congress passed the Patient Protection and Affordable Care Act (ACA) in 2010 to guarantee basic health insurance to all citizens.  During his term in office, President Trump vowed to “repeal and replace” this law but although it has been modified, it is still in place.

Healthcare for military service members, veterans ,and their families

During the American Revolution the fledgling government extended health care benefits to the soldiers and veterans of that war; that system evolved into the current Department of Defense military health care system which covers service members and the Veterans’ Administration system for veterans.

a Veterans Administration clinic
a Veterans Administration clinic (photo by Dr. Aletha)
American soldiers serving in Afghanistan
American soldiers serving in Afghanistan
Medicare and Medicaid

Two other government healthcare programs- Medicare and Medicaid are over 50 years old. 

Medicaid provides insurance coverage for adults and children who are unemployed or low income.  

Medicare covers disabled children and adults  and persons 65 years and older.

a senior adult couple relaxing in lawn chairs
by Brayden Heath from LIGHTSTOCK.COM

Department of Health and Human Services

Most of the health care activities of the federal government fall under the agencies of the Department of Health and Human Services or HHS. The Secretary of HHS serves in the President’s Cabinet.

Due to the COVID-19 pandemic, we’ve heard more about the HHS in the news than usual; maybe you’ve never heard of these agencies. Generally, management of a pandemic or other public health emergency falls within the work of the CDC.

Centers for Disease Control and Prevention

The CDC’s mission is simple but encompasses many facets of health

“to work 24/7 to protect America from health, safety and security threats, both foreign and in the U.S.”

The CDC website devotes an entire section now to information, guidelines, and news about the SARS-CoV-2 virus and COVID-19.

illustration showing the coronavirus which causes COVID-19

The goal of public health is to avoid or prevent health threats from becoming public health emergencies, like the COVID-19 pandemic. If they accomplish the mission, we hardly notice. But when an outbreak occurs, their work suddenly becomes visible, scrutinized, and debated.

The CDC director, Dr. Robert Redfield, spoke to Congress soon after the pandemic started, and his assessment of the response and funding for it were not positive. Lack of funding hampered the federal government’s response to the coronavirus outbreak, he told lawmakers on March 10, 2020.

“The truth is we’ve underinvested in the public health labs,There’s not enough equipment, there’s not enough people, there’s not enough internal capacity, there’s no search capacity”

Dr. Robert Redfield, Director, CDC

The Trump administration subsequently enlisted private companies to help cut the difference. The CDC partnered with Integrated DNA Technologies to manufacture the COVID tests under a CDC contract. IDT partnered with commercial labs for the testing.

2021-the Biden Administration

On December 7, 2020 President Biden’s transition team announced that Rochelle P. Walensky, M.D.  was slated to become the new director of the Centers for Disease Control and Prevention. In a 2021 interview she talked about the “big questions that keep her up at night.”

  • How are we going to ensure that the people who are hardest to reach with COVID vaccines receive it?
  • How are we going to ensure that when everyone else is not thinking about COVID we are still leveraging the infrastructure and connections we’ve made and that we address the collateral damage of this pandemic: the hypertension , the pediatric vaccinations that haven’t happened, HIV control?
  • How are we going to address a resurgent opioid crisis that I thought I’d never see again?
  • How are we going to address gun injury prevention?
  • How do we not only protect this nation, as we realize that we need to protect the world, too. Not just for humanitarian purposes, but because we are so integrally linked, as this virus has taught us.

National Institutes of HealthNIH

The National Institutes of Health, part of the Public Health Service,

  • supports biomedical and behavioral research with the United States and abroad,
  • conducts research in its own laboratories and clinics,
  • trains promising young researchers, and
  • promotes collecting and sharing medical knowledge.

And within the NIH is the NIAID– the National Institutes of Allergy and Infectious Diseases, which has been an invaluable source of guidance as the United States and the world works to understand and manage this new infectious disease.

President Donald Trump Visits NIH
President Donald Trump visited NIH on March 3, 2020 and toured the National Institute of Allergy and Infectious Diseases’ Vaccine Research Center (VRC) to learn about research on a vaccine for the novel coronavirus SARS-CoV-2. From left: VRC Deputy Director Dr. Barney Graham, NIH Director Dr. Francis Collins, VRC Director John Mascola, Department of Health and Human Services Secretary Alex Azar, President Trump, and VRC Research Fellow Dr. Kizzmekia Corbett.
credit NIH, public domain
Novel Coronavirus SARS-CoV-2
This scanning electron microscope image shows SARS-CoV-2 (orange)—also known as 2019-nCoV, the virus that causes COVID-19—isolated from a patient in the U.S., emerging from the surface of cells (green) cultured in the lab.
 
Credit: National Institute of Allergy and Infectious Diseases-Rocky Mountain Laboratories, NIH
President Biden Visits NIH Vaccine Research Center
NIH immunologist Dr. Kizzmekia Corbett speaks to President Joe Biden about the fundamental research that contributed to the development of the Moderna and Pfizer COVID-19 vaccines when the President visited NIH’s Vaccine Research Center on February 11, 2021. Credit: NIH/Chiachi Chang

Food and Drug Administration– FDA

The FDA joins the pandemic response by

  • reviewing and approving diagnostic tests for the coronavirus
  • protecting consumers from fraudulent products for COVID-19.
  • issuing Emergency Use Authorizations (EUAs) for ventilators
  • sampling and testing of respirators for importation

Late in 2020 the FDA gave Emergency Use Authorization to 2 vaccines against COVID-19. By December Americans began receiving “shots in arms”, a welcome step in returning to normal.

COVID-19 Diagnostic Test Attire
FDA Commissioned Corps officer RADM Estella Jones, DVM, OCET Deputy Director and Co-Chair of the FDA Animal Welfare Council, oversees Commissioned Corps officers as they practice proper fitting of protective items. Healthcare workers testing patients for COVID-19 novel coronavirus infection must wear specific protective gowns, gloves, ventilation masks, and full facial shields as shown, and must replace these items after each patient is tested. credit FDA, public domain

Occupational Safety and Health administration-OSHA

OSHA is part of the United States Department of Labor. OSHA’s administrator answers to the Secretary of Labor, who is a member of the cabinet of the President of the United States.

Congress created the Occupational Safety and Health Administration (OSHA) in 1970 to

ensure safe and healthful working conditions for working men and women by setting and enforcing standards and by providing training, outreach, education and assistance.

For the pandemic response, OSHA offers guidance on

  • returning to work
  • preparing workplaces for COVID-19
  • worker exposure risk to COVID-19
  • for specific industries including airlines, farms, retail, corrections
  • use of respiratory protection equipment

important laws that administer and regulate both private and public healthcare.

The Affordable Care Act- ACA
Health Insurance Portability and Accountability Act-HIPPA
Emergency Medical Treatment and Labor Act- EMTALA
Americans with Disabilities Act-ADA
Family Medical Leave Act-FMLA
replica of the Liberty Bell at Disney World, Florida, photo by Dr. Aletha

Let Freedom Ring

In the Declaration of Independence, the founders of the United States created a nation based on the “self-evident truths”  of  “Life ,Liberty, and the pursuit of Happiness” and to promote “Safety and Happiness” . 

They didn’t mention “healthcare” either, maybe because in the late 1700s medical practice was more superstition than science.

Surgery was rudimentary due to no anesthesia and infections frequently proved deadly due to no antibiotics.

No one had even imagined, much less identified the human genome, and viral DNA-what was that??

I wonder if they intended their new government to spend so much time and money providing and regulating health care –most of which was not available or even imagined at that time? 

Public vs Private-not a perfect Union

The United States’ healthcare system combines public health efforts with mostly private delivery of health care. Usually they coexist side by side with some but infrequent interaction.

The public health emergency created by the pandemic forced them into a “union” that quickly became politicized, and unfortunately diminished the effectiveness of the response.

But despite the lack of coordination and cooperation between all levels of government and private citizens, our health care professionals, in both public health and private medical practice stayed true to their calling. Many risked their own lives to care for COVID-19 victims. Others sacrificed time and finances to lead the pandemic response in their communities and on social media- maybe not perfectly, but definitely UNITED in resolve to lead, help, and heal their fellow citizens through this unprecedented health emergency.

Let’s celebrate!

woman holding a sprakler
Let’s celebrate ! This photo and featured image from stock photo site- Lightstock.com (affiliate)

Sharing and celebrating the HEART of life, liberty, and the pursuit of HEALTH and happiness

Thanks for following this blog. If you’re visiting, I would love for you to start following Watercress Words : use the form to get an email notification of new posts. Don’t worry, you won’t get anything else from me. I also want you to find and follow me on Facebook, Pinterest , Instagram, and LinkedIn .

Dr. Aletha 

a woman in a red, white, and blue shirt
Me, a few years ago, showing my patriotic spirit by posing in red, white, and blue

Enjoy the solitude of reading with these 7 books

So many of the serious problems we face in the world today—from illness, to social unrest, to economic disparity, and environmental degradation—are all, at their core, connected to food.

In a TIME magazine article, A literary feast, authors Bruner, Gutterman, and Lang wrote

This year, the warmest months bring more than sun: crowds are back. And surrounded by people, the solitude of reading feels somehow richer.

TIME, June 21/28, 2021

The article offers brief reviews of 36 new books which they say “will provide entertainment, distraction and comfort.” I read through the list looking for books with a medical, health, wellness connection; I’m suggesting these 7.

Like many of my book posts, these do lead to affiliate links, which if you use for a purchase, can provide funding for this blog. Or you can just check them out from your local library.

We Are What We Eat: A Slow Food Manifesto by Alice Waters

In We Are What We Eat, Alice Waters urges us to take up the mantle of slow food culture, the philosophy at the core of her life’s work. When Waters first opened Chez Panisse in 1971, she did so with the intention of feeding people good food during a time of political turmoil. Customers responded to the locally sourced organic ingredients, to the dishes made by hand, and to the welcoming hospitality that infused the small space—human qualities that were disappearing from a country increasingly seduced by takeout, frozen dinners, and prepackaged ingredients. Waters came to see that the phenomenon of fast food culture, which prioritized cheapness, availability, and speed, was not only ruining our health, but also dehumanizing the ways we live and relate to one another.

Working with regional farmers, Waters and her partners learned how geography and seasonal fluctuations affect the ingredients on the menu, as well as about the dangers of pesticides, the plight of fieldworkers, and the social, economic, and environmental threats posed by industrial farming and food distribution. So many of the serious problems we face in the world today—from illness, to social unrest, to economic disparity, and environmental degradation—are all, at their core, connected to food. Fortunately, there is an antidote.

Waters argues that by eating in a “slow food way,” each of us—like the community around her restaurant—can be empowered to prioritize and nurture a different kind of culture, one that champions values such as biodiversity, seasonality, stewardship, and pleasure in work.
 
 

The Ugly Cry: A Memoir by Danielle Henderson

Abandoned at ten years old by a mother who chose her drug-addicted, abusive boyfriend, Danielle was raised by grandparents who thought their child-rearing days had ended in the 1960s. She grew up Black, weird, and overwhelmingly uncool in a mostly white neighborhood in upstate New York, which created its own identity crises. Under the eye-rolling, foul-mouthed, loving tutelage of her uncompromising grandmother—and the horror movies she obsessively watched—Danielle grew into a tall, awkward, Sassy-loving teenager who wore black eyeliner as lipstick and was struggling with the aftermath of her mother’s choices. But she also learned that she had the strength and smarts to save herself, her grandmother gifting her a faith in her own capabilities that the world would not have most Black girls possess.

With humor, wit, and deep insight, Danielle shares how she grew up and grew wise—and the lessons she’s carried from those days to these. In the process, she upends our conventional understanding of family and redefines its boundaries to include the millions of people who share her story.

This Is Your Mind on Plants by Michael Pollan

Of all the things humans rely on plants for – sustenance, beauty, medicine, fragrance, flavor, fiber – surely the most curious is our use of them to change consciousness: to stimulate or calm, fiddle with or completely alter, the qualities of our mental experience. Take coffee and tea: People around the world rely on caffeine to sharpen their minds. But we do not usually think of caffeine as a drug, or our daily use as an addiction, because it is legal and socially acceptable. So, then, what is a “drug”? And why, for example, is making tea from the leaves of a tea plant acceptable, but making tea from a seed head of an opium poppy a federal crime?

In This Is Your Mind on Plants, Michael Pollan dives deep into three plant drugs – opium, caffeine, and mescaline – and throws the fundamental strangeness, and arbitrariness, of our thinking about them into sharp relief. Exploring and participating in the cultures that have grown up around these drugs while consuming (or, in the case of caffeine, trying not to consume) them, Pollan reckons with the powerful human attraction to psychoactive plants. Why do we go to such great lengths to seek these shifts in consciousness, and then, why do we fence that universal desire with laws and customs and fraught feelings?

In this unique blend of history, science, and memoir, as well as participatory journalism, Pollan examines and experiences these plants from several very different angles and contexts, and shines a fresh light on a subject that is all too often treated reductively – as a drug, whether licit or illicit. But that is one of the least interesting things you can say about these plants, Pollan shows, for when we take them into our bodies and let them change our minds, we are engaging with nature in one of the most profound ways we can.

Fox and I: An Uncommon Friendship by Catherine Raven  

When Catherine Raven finished her PhD in biology, she built herself a tiny cottage on an isolated plot of land in Montana. She was as emotionally isolated as she was physically, but she viewed the house as a way station, a temporary rest stop where she could gather her nerves and fill out applications for what she hoped would be a real job that would help her fit into society.

In the meantime, she taught remotely and led field classes in nearby Yellowstone National Park. Then one day she realized that a mangy-looking fox was showing up on her property every afternoon at 4:15 p.m. She had never had a regular visitor before. How do you even talk to a fox? She brought out her camping chair, sat as close to him as she dared, and began reading to him from The Little Prince.

Her scientific training had taught her not to anthropomorphize animals, yet as she grew to know him, his personality revealed itself and they became friends. From the fox, she learned the single most important thing about loneliness: we are never alone when we are connected to the natural world. Friends, however, cannot save each other from the uncontained forces of nature.

Fox and I is a poignant and remarkable tale of friendship, growth, and coping with inevitable loss—and of how that loss can be transformed into meaning. It is both a timely tale of solitude and belonging as well as a timeless story of one woman whose immersion in the natural world will change the way we view our surroundings—each tree, weed, flower, stone, or fox.

Goldenrod: Poems by Maggie Smith

With her breakout bestseller Keep Moving, Maggie Smith captured the nation with her “meditations on kindness and hope” (NPR). Now, with Goldenrod, the award-winning poet returns with a powerful collection of poems that look at parenthood, solitude, love, and memory.

Pulling objects from everyday life—a hallway mirror, a rock found in her son’s pocket, a field of goldenrods at the side of the road—she reveals the magic of the present moment. Only Maggie Smith could turn an autocorrect mistake into a line of poetry, musing that her phone “doesn’t observe / the high holidays, autocorrecting / shana tova to shaman tobacco, / Rosh Hashanah to rose has hands.”​

Slate called Smith’s “superpower as a writer” her “ability to find the perfect concrete metaphor for inchoate human emotions and explore it with empathy and honesty.” The poems in Goldenrod celebrate the contours of daily life, explore and delight in the space between thought and experience, and remind us that we decide what is beautiful.

The Family Firm: A Data-Driven Guide to Better Decision Making in the Early School Years (The ParentData Series Book 3) by Emily Oster

In The Family Firm, Brown professor of economics and mom of two Emily Oster offers a classic business school framework for data-driven parents to think more deliberately about the key issues of the elementary years: school, health, extracurricular activities, and more.

Unlike the hourly challenges of infant parenting, the big questions in this age come up less frequently. But we live with the consequences of our decisions for much longer. What’s the right kind of school and at what age should a particular kid start? How do you encourage a healthy diet? Should kids play a sport and how seriously? How do you think smartly about encouraging children’s independence? Along with these bigger questions, Oster investigates how to navigate the complexity of day-to-day family logistics.

Making these decisions is less about finding the specific answer and more about taking the right approach. Parents of this age are often still working in baby mode, which is to say, under stress and on the fly. That is a classic management problem, and Oster takes a page from her time as a business school professor at the University of Chicago to show us that thoughtful business process can help smooth out tough family decisions.

The Family Firm is a smart and winning guide to how to think clearly–and with less ambient stress–about the key decisions of the elementary school years.

Seeing Ghosts: A Memoir by Kat Chow

Kat Chow has always been unusually fixated on death. She worried constantly about her parents dying—especially her mother. A vivacious and mischievous woman, Kat’s mother made a morbid joke that would haunt her for years to come: when she died, she’d like to be stuffed and displayed in Kat’s future apartment in order to always watch over her. 

After her mother dies unexpectedly from cancer, Kat, her sisters, and their father are plunged into a debilitating, lonely grief. With a distinct voice that is wry and heartfelt, Kat weaves together a story of the fallout of grief that follows her extended family as they emigrate from China and Hong Kong to Cuba and America. 

Seeing Ghosts asks what it means to reclaim and tell your family’s story: Is writing an exorcism or is it its own form of preservation? The result is an extraordinary new contribution to the literature of the American family, and a provocative and transformative meditation on who we become facing loss.

exploring the HEART of health through reading

Thanks for following this blog. If you’re visiting, I would love for you to start following Watercress Words : use the form to get an email notification of new posts. Don’t worry, you won’t get anything else from me. I also want you to find and follow me on Facebook, Pinterest , Instagram, and LinkedIn .

Dr. Aletha

Look for these books at BOOKSHOP.ORG and Amazon.com