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Yale Public Health SPRING 2010 Can “sin taxes” cut bad health? Communicating health | Testing HIV | Russia’s epidemics Palm reading | Health without reservation Yale school of public health Yale Public Health SPRING 2010 2 Dean’s Message 3 Editor’s Note 4 Advances 7 Perspective 8 Lifestyle levies Do “sin taxes” result in better health choices—and should government be in the business of policing diet and lifestyles? 13 Communicating health An advisory about antidepressants and pediatric suicidality demonstrates the challenges of accurately informing the public. 17 A tumult over testing When it comes to HIV screening, questions of who, how and when are deceptively complex and the topic of fierce debate. 20 A conversation with Ursula Bauer 22 Russia’s “unchecked” epidemic 23 Desperately seeking soda 24 A return to China 25 Founding family visits YSPH 26 Students 30 Alumni 34 YSPH Notes 43 In Memoriam 44 Yesterday 45 Today Tobacco is the target of increasing “sin taxes” as lawmakers in many states seek to raise revenue and persuade people to give up the habit. Yale school of public health Dreamstime Dean’s Message Building better health care As we enter the new decade, it is they get), and further, the care people appropriate to reflect upon our many are getting is not of the highest quality “In simple terms, accomplishments and remaining and it costs more than it should. challenges. The mission of the Yale The health care reform bill recently people across the School of Public Health is to provide passed and signed into law by President “… leadership to protect and improve Obama, provides protections for pa- country are not the health of the public. Through in- tients with pre-existing conditions and novative research, policy analysis, and extends coverage to tens of millions of getting the care education that draws upon multidis- currently uninsured people. This new ciplinary scholarship from across the legislation is an incredibly important they need (or do graduate and professional programs at step in improving health care and Yale, the school serves local, national, disease prevention services, but there and international communities with its is much more that needs to be done. not need all the care knowledge and expertise.” Better insurance rules and coverage In previous issues of this magazine, are necessary, but not sufficient, for they get), and we have highlighted YSPH research comprehensive health care reform. programs both in the United States Although many may be deeply disap- further, the care and abroad that will help us fulfill pointed that more was not achieved in this mission. In this issue we again the current legislation, there may be people are getting is describe a wide spectrum of activities, advantages to making further, incre- with a focus on one of our strengths: mental changes away from the heat of policy research and analysis. the initial political debate. not of the highest Disease prevention and the reform Although most scientists are, and of health care policy are certainly should be, opinionated about a range quality and it among the pressing challenges that of policy issues, they rely on objective our nation needs to address. In recent data and the latest research methods costs more than it months, it has been hard to find a to answer some of the most difficult newspaper or magazine that does not questions facing us. In these pages, should.” discuss the problems with our current you will read about several examples strategies for financing and delivering of the impressive research that mem- health care and the need for reform bers of our faculty are conducting of our health care “system.” Although on important policies related to how many of these discussions have fo- we protect and improve health in the cused on the political considerations United States and around the world. affecting different legislative proposals I think you will be reassured, as I am, under consideration in Washington, that some of the best researchers in the the underlying motivation for health country are focusing on ways to im- care reform was the long-standing prove the effectiveness and efficiency realization that current strategies for of disease prevention strategies and providing health care in the United delivery of health care services to all. States are not equitable, effective or ef- ficient. In simple terms, people across Paul D. Cleary, Ph.D. the country are not getting the care Dean, Yale School of Public Health they need (or do not need all the care 2 yale public health Editor’s Note The nuances of public health policy Yale Public Health In this issue of Yale Public Health we And then there are questions of The Journal of the Yale School of Public Health explore several public health policy consistency and fairness. If one prod- Spring 2010, Vol. 2, No. 1 questions and, in particular, how even uct is targeted for increased taxation Dean the most well-intentioned and seem- (such as soda), then shouldn’t other Paul D. Cleary, Ph.D. The Anna M.R. Lauder Professor of Public Health ingly straightforward initiatives can be less-than-healthy items (cookies and deceptively complex. candies) be subject to similar levies? Editor “Where do you draw the line?” Rosalie J. Blunden Ongoing research by Yale School of Public Health faculty shows how Sindelar asks. Managing Editor relatively small policy changes can Also in this issue we look at Michael A. Greenwood often have unintended, and potentially faculty work on the repercussions of Copy Editor negative, consequences. And even the the government’s decision to issue a Anne Sommer soundest policy is likely to run into black-box warning on antidepressants; Design problems as it encounters political op- approaches to HIV testing; and the AH Design challenges involved in changing Rus- Angie Hurlbut and Nilou Moochhala position, economic shortfalls or public apathy—and possibly all three. sian policies (and attitudes) toward Address correspondence to Jody Sindelar and Jason M. Fletcher, HIV and drug addiction. These are all Managing Editor, Yale Public Health 60 College Street for instance, continue to analyze the compelling, important and nuanced P.O. Box 208034 efficacy of so-called “sin taxes” on public health issues that are being New Haven, CT 06520-8034 products such as tobacco, alcohol actively debated today. They are also Phone: 203-737-5151 Fax: 203-785-7296 and, increasingly, soft drinks and fast issues that defy quick answers or obvi- E-mail: [email protected] food. Such taxation certainly raises ous solutions. Web: publichealth.yale.edu much-needed revenue for govern- On an unrelated note, Yale Public Yale Public Health is published twice a year and ment coffers. But the policy also raises Health invites its readership to write is distributed to alumni, faculty, students and difficult questions: Do the taxes really letters to the editor on the topics friends of the Yale School of Public Health. promote better health? Is it the pur- covered in this and future issues. We Acronyms used in Yale Public Health include view of government to interfere with want to hear from you and print your YSPH for Yale School of Public Health and personal dietary choices? Are privacy opinions as we continue to fine-tune LEPH for Laboratory of Epidemiology and Public Health (the school’s main building). and personal freedoms being sacrificed our focus and strive to make this the in the process? best magazine possible. Cover art by Paul Zwolak To try and answer these tricky Printer questions, researchers study things Michael Greenwood Pyne-Davidson Co. such as “externalities,” or the hidden Managing Editor 237 Weston Street Hartford, CT 06120 costs and effects that an individual’s choices have on the larger commu- nity. In some areas the consequences are pretty clear-cut; in other cases the answers are vague, if not outright Printed on recycled paper with soy-based inks elusive. spring 2010 3 Advances Childhood ADHD, adult 2 percent and 10 percent of schoolchil- time for testing and for t-PA to be crime linked dren in the United States are affected administered. by ADHD. “One of the greatest challenges for Schoolchildren with attention deficit acute stroke care is getting patients to Michael Greenwood hyperactivity disorder are “substan- the hospital as soon as possible once tially” more likely to engage in many they experience stroke symptoms, types of criminal activity, such as so that therapy is given within the burglary, theft and drug dealing, as treatment window,” Lichtman said. they grow older than schoolchildren The study found that only about 37 without this disorder. percent of all stroke patients arrived These research results are believed at the hospital in time, and African- to be the first evidence from a national American patients were 44 percent study of a link between the common less likely than their Caucasian peers childhood condition known as ADHD to arrive within two hours of the and illegal activity. The YSPH study Roux Christian onset of symptoms. found that children with ADHD, for “We need to get better at educating example, were nearly twice as likely to Patients arriving too late for the public about how to recognize the commit theft later in life and were 50 stroke drug signs and symptoms of stroke,” Licht- percent more likely to sell drugs than man said. children without ADHD. Most stroke patients arrive at the M.G. The findings suggest that children hospital too late to take advantage of exhibiting ADHD symptoms should a clot-busting drug that significantly be viewed as an at-risk group and that reduces stroke symptoms and lessens Many mothers-to-be open to intervention programs might be an the chance of permanent disability if HIV counseling appropriate response.
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