Public Health – Marilyn R. Gardner

Statistics are Like Bikinis

Published on March 13, 2012November 13, 2013 by Marilyn10 Comments

“Do you realize that the United States spends forty percent of their GDP on healthcare?!” I said indignantly to some friends a while ago. Our friend Jon, a professor of mathematics, looked at me in surprise “Forty percent?” he said “That seems really high”. “I know!” I said, even more indignantly! “Canada spends only ten percent!”

I have heard it said that fifty percent of statistics are made up on the spot. Well – there you have it; I am guilty as charged. While the United States does spend significantly more than Canada on healthcare, it is more like eighteen percent — not the forty that I passionately and indignantly claimed. In a moment of passion I forgot the real figure and made it up on the spot. I was the only one in the room that had significant knowledge of the healthcare system in this country and so I was only vaguely questioned. Had my friend not been a math professor I would not have been questioned at all.

What is it with the western world and statistics? We LOVE them! We love to prove our points through those elusive numbers. Why? Is it because you can argue with a story, but you can’t argue as well with numbers?

“Statistics are like bikinis. What they reveal is interesting and what they conceal is necessary”

I heard this quote several years ago and have found many occasions since that time to use it. I love it. In my working hours I live in a world of empirical data, numbers, and evidence-based programs. It’s a world where the quantitative, or numbers, trumps the qualitative, or stories. It’s a world where grant funding is fought for and millions of dollars are either awarded, or not awarded, based on data. It’s also a world where it’s possible to manipulate data and just show what you want to show – thus the bikini analogy.

In fact, as I said above, the west as a whole loves numbers. Think about it for a minute. You can hardly listen to a news program without having those ominous numbers thrown at you. And what percentage of statistics are wrong because they are bought into the way preteens with limited body parts buy into bikinis? What percentage are wrong because of bias? Because of the way words are used to state the statistic? Because they are made up on the spot?

I grow tired of the numbers. I grow tired of the statistics – and yet I know that through them, through these numbers, we receive money to do some important work in communities that have needs and problems. We also receive money to do work in communities that are not needy – because statistics are like bikinis. We can twist them this way and that, covering up those essentials, moving the little top here and twisting the panties there until we have the perfect set up. The set up that will guarantee maximum attention and be quite interesting, perhaps even eye-popping, to look at. But all that is concealed? What is concealed is necessary and so other communities, made up of needier people, lose.

And all the while, I, who love the narrative, who love the stories of people; stories that show need and ingenuity, desperation and creativity, have to sit back and work out details of a program that will support the numbers.

It can be exhausting. Public health exists to reach the most people possible with the least amount of money. But the compelling narrative behind the statistic is lost in the process. For every statistic we read there is a real story, a real person, a real situation, a real heartache or crisis, a real disease, pregnancy, or cancer, In our effort to analyze and quantify we often fall short of reaching the story.

I don’t have an answer to this. I know numbers do matter and I know that when you have only the story, you have a bikini as well, so this quote helps me to dig a little deeper. To be willing to share and fight for the single story in the midst of the overwhelming data that supports the numbers. Fight for the story that is right in front of me, significant but somehow concealed.

What do you think? Do you get caught up in statistics or hate them? Would love to hear from you in the comment section.

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Your Health is in Your Zip Code

Published on August 16, 2011 by Marilyn2 Comments

Is inequality making us sick?

This is the telling question asked in a video series produced by California Newsreel and shown by PBS a couple of years ago. As a public health nurse I use this series often to draw attention to the wide gap between people and neighborhoods that exists when it comes to health. It seems that our zip codes have more to do with our health than our genetic code. This is a serious indictment. While we hear about the “widening gaps” between rich and poor and the problem with distribution of wealth, rarely does anyone drill it down to diseases people get, life span, and all the other factors that go into overall wellness.

All of us, regardless of our station in life, interact with the world around us. And it is in this world that our health is created. So if we live in a neighborhood that has clean air, wide sidewalks, well-lit streets and play grounds, along with affordable farmers markets for fruit and vegetables, we have a far better chance at health than the person who has none of these things. Turns out that person is far more likely to struggle with asthma, lack of physical activity, obesity and poor nutrition.

As debates on health and healthcare continue it makes sense to focus on these most basic things, termed in the public health world as the “social determinants of health“. The World Health Organization explains these determinants this way: “the conditions in which people are born, grow, live, work and age, including the health system”. Paying attention to these determinants would change outcomes to a degree that any costs incurred would be covered through reduced rates of diabetes, high blood pressure, heart disease and the list could go on and on. Transforming neighborhoods does as much or more to increase health and wellness as diet and exercise.

Nancy Krieger, an epidemiologist from Harvard School of Public Health says this: “We interact constantly with the world in which we are engaged. That’s the way in which the biology actually happens. We carry our history in our bodies, how could we not?”

The question becomes how can we, how can I, be a part of changing the communities where we live world-wide? While I believe governments, both state and federal, can help with policies, they aren’t the ones who can create communities that care. Only people who live within those communities have the capacity to do that. So as we bicker about politics and point fingers we’re wasting a lot of time. Time that could be spent in helping to transform.

Take a look at the introduction to the series and see what you think.

UNNATURAL CAUSES | About the series . Video clips | CALIFORNIA NEWSREEL.

Hookah Hypocrisy

Published on June 9, 2011December 7, 2012 by Marilyn15 Comments

I am a hookah hypocrite. As a public health nurse I am the first to rail against cigarette smoke, excessive alcohol use, and hook-up culture. I believe all are public health issues and hurt not only individuals, but communities.

And I am a hypocrite. Because I have been known to give my sixteen year olds hookahs as rites of passage and sit in a comradely fashion among them puffing my way through mango tobacco. When I excitedly told my friend Cathy (who knows me well) that I had found a hookah, the perfect gift for my son’s sixteenth birthday, the conversation went like this:

She: “You gave him a bong?”

Me: “A What?”

She: “A bong”.

Me: “What’s a bong?”

Turns out, a bong is a hookah but the word is used primarily in relation to marijuana use. No way did I give my son a bong! I would NEVER have given my son a bong. I’m a public health nurse! I gave him a hookah. In my mind, these were two totally different things. Hookah hypocrisy. But before you cast a stone, let me explain the roots of this hypocritical stance.

Seven years in the Middle East and fragrant warm evenings sitting at Fishawis’s Cafe in the famous Khan-el-Kalili bazaar with a hookah (or

shisha), your choice of flavored tobacco, and mint tea is an unforgettable cultural experience. Those who know our family know the times we have ached to be back in the land of palm trees and shisha, warm hospitality and shawarma, revolutions and passion. It is those times that have led me down the hypocritical path of shisha endorsement, caught on camera film for all the world to see. It is trying to explain the cultural aspect of this that gets me in trouble with the mother who calls and asks who I think “Introduced the boys to the hookah? It’s just one more thing to worry about…” chagrined I own up and take responsibility for my hypocrisy. The mom goes on to tell me about the article in the NY Times that speaks in journalistic detail of the dangers of hookah smoke. She goes on to tell about the letter to the editor that followed the article from the esteemed president of the American Academy of Pediatrics. Although I want to shut her up, I stand duly rebuked.

I want to be able to qualify my actions through a cross-cultural lens, letting those who disapprove know that we don’t smoke shisha more than once or twice yearly. That when we do it’s a bonding event and no more than a few weak puffs are taken. But at the end of the day, I don’t have an excuse for either my endorsement or my behavior.

A deeper analysis helps me recognize that just as I want people to be able to understand my hookah hypocrisy, as both a nurse and human being, I need to be capable of understanding theirs. But today I’m not going there. I’m confessing to the world that I am a hypocrite and remain convinced of the magic of warm evenings and shisha smoke on outside patios.