Our group of interns will consider obesity as a public health issue and also an issue of racial and economic health disparities.  We will then consider several different examples of suggested food and other policies designed to curtail obesity at local, state and national levels, and interns will evaluate the literature and theories behind each of these policies.  Finally, interns will synthesize this information to create recommendation plans for their own locales, which will include taking a political action.  A big focus of the work this semester will be to connect national news and policy discussions to a local analysis of each intern’s community.

Topic 1:  Introductory Readings on Obesity in the US and a brief overview of weight-associated topics like weight discrimination, childhood nutrition, and fast food in the media.  We will do a brief survey of the presentation of the issue in the popular media.  Interns will look for references to the issue in their local media and local events.

Topic 2:  Obesity as a Public Health issue

We will listen to some short podcasts from the CDC/NIH on the increase of obesity among the adult population and learn about the federal govt. initiatives like Healthy People.  Interns will begin collecting information about health and obesity in their own local area and gain experience compiling and interpreting public health statistics.  This work will also provide a preliminary look at demographic differences in health and obesity.

This will also include a brief reading from the Robert Wood Johnson Foundation “Healthy Americans” report as an example of some national-level statistics.

Topic 3: Health Disparities and Food Deserts

We’ll listen to a podcast by a top CDC official that considers the disparities in the effects that obesity is having on different ethnic/racial groups, and the disproportionate health effects that are happening as a result.  We’ll use this as an introduction to this week’s HW assignment which will consider–are there disparities in people’s access to healthy foods?  We will consider the idea of nutrient-dense vs. calorie-dense foods, and then check out a presentation from Yale’s Rudd Center introducing us to the idea of food deserts.  Then we’ll do a mapping exercise in our own communities to see if there are correlations between food access and poverty levels.

Assignment–Create a food access map of your community similar to the one for the Bronx prepared by the Rudd Center.

Topic 4:  Menu Labeling

We’ll view a presentation that considers the history of caloric/food package labeling, and look at the recent work in Philly and NYC to label chain restaurant menus with calories.  We’ll also look at a Powerpoint called “Nanny State or Public Good?” to consider different personal philosophies on public health interventions.  We will discuss these philosophies at our weekly group chat.

Assignment–Short paper on the labeling requirements in your city and/or state

Topic 5: The Sugar Tax–We’ll investigate the debate over proposed taxes on sweetened beverages as a method of reducing obesity in America.  This will include reading an excerpt from the recently released USDA report on sweetened beverage taxes.

Assignment–We’ll do a caloric and nutritional analysis of different beverages that we run into across the course of the week.  We’ll also do some research on white sugars vs. HFCS (high-fructose corn syrup) and each develop 2 talking points summarizing our views on the issue–i.e., is HFCS worse than sugar, or not–what does the actual scientific research say?

Topic 6:  Food Marketing–We’ll look at the controversy over fast food marketing through the analysis of a few very recent examples, like the big push against the inclusion of toys on McDonald’s Happy Meals.

Assignment–A message analysis of a food ad, as well as a brief analysis of fast food marketing and distribution on your own community–this will include an assignment to do some photojournalism in your area to document the marketing of foods.

Topic 7–Food Policy in the US–This week, we’ll look at the specifics of agricultural subsidies, including the argument by some that the current system should be modified to increase production of fruits and vegetables.  We’ll look more at access to healthy foods, and at recent measures to provide recipients of food assistance the opportunity to use their food “credits” at local farmer’s markets.  We won’t cover everything, of course–it is a huge topic–but we’ll focus in on a few topics of interest.  The assignment for this will mostly focus on readings and preparation for the next week’s discussion.  There will be a brief assignment in addition to the readings, to consider the agricultural systems present in your own state as well as your own community.

Topic 8–Exercise Promotion–We’ll look at measures like workplace fitness measures, “active city” plans, and youth exercise programs.  We’ll try to think about ways to evaluate these types of programs.  Our HW will consider the layout of our town or city and how conducive it is to physical activity on a daily basis—will include the creation of some maps.

Topic 9–We’ll be working on our final projects at this point (see below), but we will take this week to  look at a few School Policy and Nutrition readings.  They’ll look at things like the School Breakfast and Lunch programs; research looking at the potential link between food insecurity and obesity; the level of nutrition of school lunches, and recent events that have limited the sale of junk foods in school vending machines.  Bonus assignment–report on the current status of your local schools in terms of food access and nutritional quality.

Topic 10–Wrapup and sharing of final ideas

Final Project:  Over the course of the last 3 weeks, interns will develop a short report laying out what they think would be the most effective strategy–or strategies–for their own locality (city, town, etc) to combat obesity.  They will lay this out in a Problem–Solution format in which they provide justification for their viewpoints.  They will use the research that they have performed throughout the semester on their area to compile these reports.  We will then compile all of the reports together into a booklet that includes the food maps the interns have created and their photo-documentaries.

Weekly meetings:   We will participate in weekly evening group chats.

Political Action:  Interns will be asked to turn their final report into a brief Letter to the Editor and/or letter to their mayor that expresses their own personal opinions–and they will be encouraged to actually submit this.  Also, during the semester, I will select a food/nutrition-related bill that is coming up for a vote (will be challenging in election season) and ask each intern to call their Senator/Rep expressing an opinion on the bill (they can take whatever side they would like to on the bill).

Finally, each intern will submit either an op-ed piece or letters to their legislators and/or mayor that communicates these recommendations. Interns with interests in public health, medicine, biology, geography and/or statistics may be particularly interested in this committee, but interns of all backgrounds are welcome.

Forensic Science Action Team, led by Jamie Vernon, Ph.D. This group will focus on policies that can literally be the difference between life and death for thousands of Americans.  Specifically, you will analyze policies related to forensic science.  According to a 2009 report issued by The National Research Council, the US forensic-science system is under-funded, lacks oversight and is poorly supported by research.  Because of these deficiencies in the system, the risk of executing an innocent person is unacceptably high. You will examine the current state of forensic science and suggest policies that will improve the science used by prosecutors in our courts of law.  In addition, you will help to create an internet-based Forensic Science Policy Network to share our findings with the public.

Personalized Medicine Research Team, led by Mary Cloud Ammons, Ph.D. The recent announcement by the FDA to regulate the sales of personal genetic test kits as medical devices has brought the issue of personalized medicine to the forefront of future medical care; however, the issues of personalized medicine goes well beyond our ability to now test for genetic signatures associated with disease prediction. The focus for this internship group will go beyond the current issue of over-the-counter genetic tests and address how health care in the information age

Water Security Research Team, led by Matt Wenham, Ph.D. In many areas around the world, fresh water is a scarce resource and access to it is a major concern. Uses such as human consumption, agriculture, power generation and environmental management compete for limited supplies, leading to conflicts between communities, industries and sometimes nations. The Water Security group will look at policy issues around the provision of fresh water at the local, national and international level, ranging from local water supply in the US to cross-border water conflicts. We will particularly focus on how scientific research can inform policy decisions to ensure equitable and sustainable access to this vital resource.

Science Communication Team, led by Michele Kadnar, Ph.D. This group will examine the link between science communication and media, politics, and ultimately public opinion. We will examine strategies for communicating science and how they can influence support for a particular policy. Each intern will choose a topic of their own interest to investigate how different communication strategies can affect the public’s perception of the scientific message and, ultimately, legislation related to that issue. The variety of topics examined in the group will allow for the comparison of different communication techniques.

Reading list for the Science Communication Group

1. Do Scientists Understand the Public? Mooney C. American Academy of Arts and Sciences. 2010.

2. Are scientists really out of touch? Dietram A. Scheufele, Dominique Brossard, Sharon Dunwoody, Elizabeth A. Corley, David Guston, and Hans Peter Peters. The Scientist. August 4^th 2009.

3. Public Praises Science; Scientists Fault Public, Media

Scientific Achievements Less Prominent Than a Decade Ago

The Pew Research Center for the People and the Press. July 9, 2009.

4.  Is there a better word for Doom? Seedmagazine.com May 21, 2009.

5. Reflections on American Academy’s Report: Do Scientists Understand the Public? Matthew Nisbet. June 20, 2010 Blog: Framing Science

6. What’s next for science communication? Promising directions and lingering distractions Nisbet and Scheufele Am. J. Bot..2009; 0: ajb.0900041v1-0

7. Models of public communication of science and technology

Lewenstein B Public Understanding of Science 16 June 2003.

8. Science and society. Framing Science. Nisbet MC, Mooney C.

Science. 2007 Apr 6;316(5821):56

9. The Future of Public Engagement. Nisbet and Scheufele The Scientist October 2007

10. 2003 Nanotechnology Research and Development Act

11. Public Engagement with Nanotechnology by David Guston. March 30, 2010. Blog: 2020 Science

12. Nanotechnology: from the science to the social. by Stephen Wood, Richard Jones and Alison Geldart. The Economic and Social Research Council. 2007.

13. Without effective public engagement, there will be no synthetic biology in Europe. C Macilwain. World View: Talking the Talk Column.  Nature 465, 867 (2010) | doi:10.1038/465867a

14. Public views on GMOs: deconstructing the myths. Marris C. EMBO Rep. 2001 July 7; 2(7): 545–548.

15. Deja vu and synthetic biology – will we learn the lessons of nanotech and genetic modification Hillary Sutcliffe May 25^th 2010. Blog: Sciecne2020. [and links therein]

16. Why the Future Doesn’t Need Us. Bill Joy. Wired 8 April 2000.

Blog roll

Specific articles from these blogs and others will be chosen for students at week 2 (perhaps week 1) after they submit their topics to me.

http://2020science.org/

http://www.scienceprogress.org/

http://scienceblogs.com/framing-science/ (no longer posting- posting at bigthink.com, but I find this an easier site to search)

http://bigthink.com/blogs/age-of-engagement

Books (optional)

Don’t Be Such a Scientist by Randy Olson

Escape from the Ivory Tower by Nancy Baron

Am I Making Myself Clear by Cornelia Dean

http://www.aolnews.com/category/nanotech/ I Making Myself

Tips for Writing Op-eds

The Op-Ed Project: Tips for Op-Ed Writing

How to Read a Column by William Safire

*may adapt some of these techniques in writing

Talking points

Week 1:

• According to a recent study, scientists are viewed as the voice of authority and are trusted by the public. However, scientists need to communicate in a way that the public will respond to.
• Scientists often blame public ignorance and scientific illiteracy for their perceived lack of public interest in or support for a scientific issue. However, scientists often fall into the trap of believing their science speaks for itself in terms of serving the greater good.
• In general, scientists are wary about talking to the media and the public. Yet, scientists in certain subfields, such as nanotechnology, actively engage the public. These subfields often use “ambassador organizations” to interact with the public.
• Scientific communication should include technical applications and social values, not just scientific facts. Scientists can partner with social scientists and public opinion experts to learn about potential controversies.
• There are already latent meanings to certain words in common use. Involving experts in the social sciences will help scientists to understand the terms of a policy debate before it begins.

Week 2:

• People tend to look for shortcuts to make up their mind. Throwing information at people is not the most effective approach to communication.
• Frames are storylines that communicate why an issue matters. In framing, two concepts or things are linked. Frames are successful when they hit a nerve with people and what is important to them.
• Scientists usually work within the deficit model of communication—“if I only tell them, they will understand and see it my way.” In this method of communication personal or societal context is often lacking.
• The contextual model is “who is speaking, who is the audience, how and why” method. However, social scientists believe this model may just be a glorified deficit model.
• Scientists are not always the subject experts. The lay expertise model is the local expert model, no one understands your circumstances better than you.
• Social science research favors the public participation model, the two-way street. Often referred to as the dialogue model, it is heavily employed in Europe.

Week 3:

• Collaborations between scientists, social scientists, public engagement experts and trained communicators can build trust between the public and researchers. The National Nanotechnology Initiative (NNI) is such a collaboration.
• Popular science media entertainment media can influence the public’s perception of an issue either positively or negatively before fruits of the research are observed.
• The vision of the collaborative agencies, such as NNI, has yet to be realized. The 2003 Nanotechnology Research and Development Act was the first piece of legislation to include a pubic engagement clause yet the efforts have fallen short.
• Nanotechnology opponents use a public accountability frame. Nanotechnology is described as the asbestos of tomorrow.
• Nanotechnology proponents, such as those in Europe, use a social progress frame. Nanotechnology companies in Europe have initiated a branding campaign of “nano is nature.”

https://www.23andme.com/gen101/

Week 2
Topic: Protecting genetic information-GINA
Reading: GINA from HHS
Extra: Keeping Pace with the Times-GINA of 2008 (NEJM) and GINA-A Half Step Toward Risk Sharing (NEJM)

Week 3
Topic: Direct to consumer genetic tests
Reading: GAO Report
Extra: Risks of Presymptomatic Direct to Consumer Genetic Testing (NEJM)

Week 4
Topic: Regulation of direct to consumer genetic testing
Reading: Which Way for Genetic Test Regulation (2 papers-Nature)

Week 5
Topic: Genetic testing of the incoming freshman class
Reading: College Bound, DNA Swab in Hand (NYT)
Extra: Are There Genetic Influences on Addiction (Addiction Journal)

Week 6
Topic: Role of race in genetic testing
Reading: The Ethics of Characterizing Difference: Guiding Principles on Using Race Categories in Human Genetics

Week 7
Topic: Regenerative medicine in personalized medical care.
Reading: A Brief Definition of Regenerative Medicine (Regenerative Medicine Journal)
Extra: An Overview of Stem Cell Research and Regulatory Issues (Mayo Clinic Proceedings)

Week 8
Topic: Primary care shortage and innovations in personalized medicine.
Reading: Innovative Health Programs Counter Primary Care Shortage (US Today)
Extra: To The Point Podcast

Week 9
Topic: Personalized medicine in the age of social networking
Reading: Practicing Patients (NYT)
Extra: Jamie Heywood-TED Lecture

Week 10
Topic: Personalized medicine and personal responsibility: is healthcare any of the government’s business anyway?
Reading: Health Insurance Politics in Federal Court (NEJM)
Extra: The Practice of Medicine and the Rule of Law-Justice John Paul Stevens (NEJM)

**NOTE:  There are a few places where I want to insert references, which I will need to do before I send these out to interns.

Week 1:  Introduction to the Obesity issue in the United States

(Note—since regional and ethnic and other disparities are discussed in more detail in next week’s set of readings, I have saved talking points related to those topics for the Week 2 set below).

• Obesity is defined as a condition of excess body fat.  For adults, obesity is defined as having a BMI, or Body Mass Index, value of ≥ 30.   The Body Mass Index is calculated from height and weight values.  For children, BMI values and age are used to determine weight percentiles, with childhood obesity defined as having a BMI at or above the 95^th percentile.  Overweight adults and children have BMI’s above normal levels but below the defined obesity threshold.

• The levels  of both adult and child obesity in the US have increased significantly since the 1970’s; according to the Centers for Disease Control and Prevention (CDC), the rate of adult obesity in the US is currently 26.7%–a value that almost certainly underestimates the true prevalence since surveyed Americans were asked to self-report their own weight.  Also according to the CDC, childhood obesity rates are at 17% nationally.  Shockingly, due to these high rates of childhood obesity, the life expectancy of this generation of children may be 2-5 years shorter than that of their parents!

• Obesity is a serious public health issue.  Obesity is linked to chronic health conditions like diabetes and heart disease/high blood pressure.  A 2005 medical study (JAMA) found that 112,000 excess deaths in the US per year are caused by obesity-related health issues.  According to the CDC, obese children face the same kinds of health issues as obese adults, and 4 out of every 5 of obese children will become obese adults.

• Obesity is also a serious quality of life issue.  According to the Obesity Society of America, obese Americans face reduced mobility, weight bias, workplace discrimination, discrimination by doctors, and higher rates of psychological consequences like anxiety and depression.
• Finally, obesity is a major health care issue for the country.  Rising obesity rates lead to rising health care costs; the CDC estimates that almost $150 million dollars of health care costs each year in the US are associated with obesity.  Since health care affordability is such an issue of concern right now, reducing obesity rates could be one major way to reduce system-wide health care costs.

• Due to these major health, personal/life, and financial burdens on the citizens of the US, it is essential that the United States consider and implement the most effective and/or promising strategies to reduce levels of adult and childhood obesity at national, state, and local levels.
• The causes of obesity are both genetic and environmental/behavioral.  Since the large changes in obesity levels over the last 40 years cannot be explained by large genetic changes, it is clear that changes in food intake, exercise, and other behaviors are responsible for the increases in obesity.  If we are to reduce rates of obesity in the US, we must effectively target these behavioral causes.  An increasing number of federally-led programs and panels, including Michelle Obama’s “Let’s Move” initiative, are tackling this complicated issue.

Week 2:  Obesity and Health Disparities; Overview of Government Interventions

• While adult obesity rates are currently above the US government’s goal rate (of 15%) in all US states, there are large racial, geographic, and socioeconomic differences in obesity rates, as revealed by the recently released MMWR 2009 obesity in America report from the CDC (all statistics below provided from sections of this comprehensive epidemiological report).

• Geographically, the Deep South and southern Midwest exhibit the highest rates of adult obesity, and similar patterns are observed for levels of childhood obesity.  The prevalence of adult obesity has been steadily increasing almost all states.  The lowest rates of obesity are observed in certain western and northeastern parts of the country—especially Colorado and Washington, DC.  Patterns of adult obesity prevalence correlate well with patterns of Type 2 (adult-onset) diabetes prevalence.

• Obesity rates vary widely between different racial/ethnic groups.  While the current US obesity rate is around 27%, obesity rates are significantly higher for black women and Hispanics.  Due to the health and lifestyle consequences described above, these differences in obesity rates are creating new health disparities that will add on to the health and life disparities that minority citizens of the US already face.  This provides a strong impetus for working to reduce these disparities and to reduce levels of obesity in general.

• Lower socioeconomic status correlates with increased adult obesity rates, and there is some (but not complete) correspondence between the states with the highest obesity rates and the highest poverty rates.  Other factors exhibiting some (but not complete) correlation with state adult obesity rates include levels of fruit/vegetable consumption.

• The CDC has outlined 2 ways in which the federal government can be involved in tackling obesity as a nationwide health issue—by “promoting change” through programs like First Lady Michelle Obama’s “Let’s Move” program, and by “recommending actions” through the work of groups like the federal task force that is centered around childhood obesity issues.

• State and local governments have also created their own programs and policies in an attempt to improve childhood and adult eating habits and exercise habits, ranging from calorie labeling of chain restaurant menus to “Complete Streets’ programs to encourage more walking and biking.  There is a very large variation in policies from state to state, and some cities (like Philadelphia and New York) have also developed their own laws that are designed to reduce obesity.  Increased coordination between states, to determine which policies are most effective/most promising and then to implement them in a wider range of localities, is an important step for the future.

Week 3:  Health Disparities and Food Deserts

(The talking points below are developed from a reading excerpt on the topic from the Robert Wood Johnson “F as in Fat” report, as well as the TIME magazine article.  We will read the article about Chicago and food deserts and use that as a group practice exercise to develop some useful talking points focused around the content in that specific report.)

• It has been proposed that one of the reasons for demographic disparities in obesity levels is the presence of large disparities in access to healthy foods and to suitable physical activity.

• Traditionally underserved, low-income neighborhoods are also underserved by healthy food access, a phenomenon commonly referred to as “food deserts.”  A 2009 US Department of Agriculture (USDA) study revealed that the majority (68%) of lower-income individuals do not have access to supermarkets in their area.  Instead, residents must rely on nearby fast-food establishments and convenience stores, which are more prevalent in these neighborhoods but generally carry few healthy foods like fruits and vegetables.

• It is essential to improve access to healthy food in communities, as, according to the Robert Wood Johnson Foundation, food deserts have been linked to increased rates of obesity.  Possible interventions include financial incentives for supermarkets in low-income areas, community garden projects, and urban farmers markets that accept food assistance credits.

• Lower-income communities also suffer from lower rates of access to exercise due to issues like the lack of green spaces, the lack of options for recreational exercise, and safety issues with being outside, as outlined by the Robert Wood Johnson Foundation’s “F as in Fat” report.  This reduced access has been linked to higher rates of obesity; for example, children who lack access to green spaces and recreational opportunities in their neighborhoods are 1.2 times more likely to be obese.  (need to insert reference here).

• Finally, since lower-income families and individuals often receive poorer health care services, they may not receive the necessary nutrition information and information about obesity-related diseases like Type 2 diabetes that they need.

• The Robert Wood Johnson Foundation has proposed a series of interventions to lower obesity rates in lower-income communities, including the food access interventions described above, crime reduction and community planning to encourage outdoor activity, improved educational programs and other urban planning changes.  Since the current disparities in obesity rates are reinforcing and adding to already existing socioeconomic and racial/ethnic disparities in health and lifestyle, obesity in America can be viewed as a social justice issue; it is imperative and urgent that action is taken at all levels, from local to national, to address the root causes of at least some of the disparities in obesity rates.