Not an “accident”: William Jeffrey Belk, 29, suffers fatal work-related injuries at Boise Cascade plywood plant in North Carolina
William Jeffrey Belk, 29, suffered fatal traumatic injuries on Friday, September 26 while working at the Boise Cascade Wood Products plant in Moncure, NC. News reports provide some initial information on the worker’s death:
- “The Chatham County Sheriff’s Office says a worker at a wood products company died when a piece of machinery fell on him.”
- John Sahlberg, senior vice president of Human Resources at Boise Cascade, told The Sanford Herald: “The equipment had a C-clamp, and somehow or another, the C-clamp was up and came down on him. We don’t have details as to what he was doing or why the C-clamp was up.”
The Wood Working Network reports:
“The specialty plywood mill, which Boise Cascade purchased in a year ago, produces both hardwood and softwood panels. Boise Cascade acquired the Moncure plywood mill, along with Chester Wood Products, from Wood Resources LLC in September 2013 for $102 million.”
William Jeffrey Belk is survived by his wife, three sons, and three daughters.
OSHA’s on-line record of inspections does not show any inspections of the workplace when it was Moncure Plywood. Since January 2010, a number of Boise Cascade operations have been inspected by State OSHA agencies in Washington, Oregon, Tennessee and South Carolina. Two of the inspections resulted in the company paying a penalty for serious violations.
Each year, dozens of workers in North Carolina are fatally injured on-the-job. The Bureau of Labor Statistics reports 104 work-related fatal injuries in North Carolina during 2013 (preliminary data, most recent available.) Nationwide, at least 4,405 workers suffered fatal traumatic injuries in 2013.
The AFL-CIO’s annual Death on the Job report notes:
- North Carolina OSHA (NC-OSHA) has 104 inspectors in the state to cover more than 215,000 workplaces.
- The average penalty for a serious OSHA violation in North Carolina is $996.
NC-OSHA has until mid-March 2015 to issue any citations and penalties related to the incident that stole William Jeffrey Belk’s life. It’s likely they’ll determine that Belk’s death was preventable. It was no “accident.”
The villagers of Setulang in Indonesian Borneo have enlisted a new ally in their fight against the illegal clearing of their forests for oil palm plantations: aerial drones. The indigenous Dayaks manage the surrounding forest conservation area, and they are hoping the drones can help them ward off illegal oil palm operations and protect their land. “Dayaks and Drones,” a video produced by Handcrafted Films, chronicles how the villagers teamed up with an Indonesian nonprofit to learn how to program and operate drones. Equipped with GPS technology, the small drones photograph the forest and monitor the area for illegal activities.
Watch the video.
Compliments to the chef: Partnerships between school food staff, professional chefs lead to healthier eating
Building excitement around school meals with the help of guest chefs and fresh recipes could be a significant boon for school lunch programs as well as student eating habits, a new study found.
Recently published in the journal Appetite, the study examined the impact of Chefs Move to Schools, an initiative of First Lady Michelle Obama’s Let’s Move campaign. With an overriding goal of encouraging schoolchildren to make healthier meal choices, Chefs Move to Schools pairs volunteer professional chefs with schools to offer cooking education to kids as well as culinary advice to school food services staff. Researchers wanted to know if bringing guest chefs into schools would positively impact school lunch program participation and whether the newly created meal offerings could increase student consumption of fruits and vegetables.
Participation in the National School Lunch Program has come under some scrutiny lately as schools transition to meet new federal nutrition standards, and guest chefs could be one way to rally student enthusiasm and inspire school meals that are healthier, yet appealing to young people. (In 2012, the U.S. Department of Agriculture in accordance with the Healthy, Hunger-Free Kids Act of 2010 issued new nutrition standards for school lunch meals. More on those changes are here.) To study the impact of the chef initiative, researchers helped organize a pilot event at an upstate New York high school and with the support of the school’s food service staff, welcomed a volunteer chef who specialized in French cuisine to participate.
Before the main event, the volunteer chef visited the school to meet with food service staff and learn about the foods available to the school cafeteria, eventually deciding to develop recipes for foods already popular with students. The guest chef, whose recipes stayed within the standards of the National School Lunch Program, made three pizzas — meat taco pizza, bean taco pizza and garlic spinach pizza — as well as a ranch burger. (The pizza was made with whole-wheat crust and low-fat mozzarella cheese, while the hamburger was made with a whole-wheat bun dusted with cool ranch seasoning.) In addition to the guest chef’s offerings, the school chef prepared a meat lover’s pizza, a mozzarella burger and pre-packaged salad with fresh greens, walnuts and raspberry vinaigrette dressing. A day before the new foods were officially rolled out, an after-school tasting was held where students could meet the volunteer chef and talk about her food creations. With excitement buzzing the next day, students filed into the cafeteria to make their meal choices.
In examining the resulting sales data and plate waste, researchers discovered that the effort did make a positive difference. They found that after the new meal items were introduced, 9 percent more students bought National School Lunch Program-compliant meals. And while plate waste showed that students ate about the same amount of their entrée as they had previously, they also ate 16 percent more of the selected vegetable sides, most notably the newly offered pre-packaged salad. Researchers speculated that the uptick in veggie consumption might have been due to the appetizing pairing of pizza and salad.
Study co-author Andrew Hanks, an assistant professor in the Department of Human Sciences at Ohio State University and an affiliated researcher with the university’s Food Innovation Center, said he and fellow researchers expected to see higher school meal participation, but the veggie part was a happy surprise.
“You market the foods and encourage kids to come and buy lunch with a tasting event, so you expect the excitement to increase and to see the increase in purchases of school lunch,” Hanks told me. “But the increase in vegetable consumption was little bit of a surprise. We’re excited to see that.”
Hanks said that while the study doesn’t tease out whether the positive impact was due to the excitement of hosting a guest chef or the actual food offerings, the whole point of the study is to examine the Chefs Move to Schools (CMTS) initiative as a package. In other words, CMTS is designed to foster long-term partnerships between professional chefs and local schools, and so the study examined the value of the initiative as a whole. Still, CMTS is not without its challenges. Study authors Hanks, David Just and Brian Wansink write:
Despite the initial fanfare at the onset of the CMTS program, tight school budgets and the narrow nutritional requirements of the National School Lunch Program, relative to those faced by professional chefs, have caused many to question the ability of professional chefs to contribute to school foods. In fact, some school food service professionals have been very vocal in their opposition. Professional chefs tend to operate with complete freedom when selecting ingredients and tend to prepare dishes that are significantly more expensive than the typical school lunch. Additionally, there are questions as to whether students would value higher quality creations over the traditional lunch fare.
Hanks told me that some resistance is natural when an outside chef comes into a school cafeteria that’s home to long-time employees. That’s why relationship building is important. In the case of the pilot event in upstate New York, the guest chef made an effort to “live in the school chef’s shoes,” Hanks said. The guest chef featured in the study was interested in learning about school foods, in learning from the school chef and she made an effort to develop her recipes using foods that were easily accessible to the school cafeteria.
Overall, the study concluded that CMTS has the potential to persuade more kids to eat healthier foods as well as increase school food service revenue, which could help offset any expenses related to new recipes and ingredients. Hanks said that while the study was a fairly small one, the results could be useful to schools in every community.
“One of the benefits of the (CMTS) program is that there’s no set rulebook that a school or chef has to play by, so each school can tailor its own program to its needs,” he told me. “Our hope is that (school) cafeterias can pick a couple elements and apply them in their own settings to enhance the experience for school lunch staff and students as well as have it be an educational opportunity for the outside chef, too.”
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.
There’s been a lot going on this past week so it’s likely that National Farm Safety Week, announced by Presidential Proclamation on September 19th may have escaped notice of those not working in agriculture. “America,” said President Obama in the proclamation, “depends on our farmers and ranchers to clothe our families, feed our people, and fuel our cars and trucks.” And he continued:
“While our farmers and ranchers are the best in the world, agriculture remains one of our country’s most hazardous industries. Producers and their families are exposed to numerous safety and health dangers — from vehicular fatalities and heat-related illnesses to injuries from falls and sicknesses from exposure to pesticides and chemicals. With preparation and proper training, these risks can be limited and lives can be saved. That is why my Administration continues to pursue innovative and comprehensive ways to lessen these hazards. We have invested in programs that improve youth farm safety, and last year, we announced plans to support the development of a national safety training curriculum for young agricultural workers.”
What caught my attention was the mention of safety training for young agricultural workers. In April 2012, much to the surprise – and distress – of those in the public health and workers’ rights community, the Obama administration withdrew its proposed regulation to increase protections for children aged 16 and under working on farms. “The decision to withdraw this rule — including provisions to define the ‘parental exemption,’” wrote the Department of Labor (DOL) in its April 2012 press release, “was made in response to thousands of comments expressing concerns about the effect of the proposed rules on small family-owned farms.”
“To be clear, this regulation will not be pursued for the duration of the Obama administration.”
The proposed rule – which the Obama administration promised not to pursue – recommended that children aged 15 and younger who are being paid to do farm work be barred from some of the most hazardous types of agricultural work, including work involving grain silos, manure pits, motor vehicles, livestock and pesticides. “Children employed in agriculture are some of the most vulnerable workers in America,” said then Labor Secretary Hilda L. Solis, announcing the proposed rule on August 31, 2011. “Ensuring their welfare is a priority of the department, and this proposal is another element of our comprehensive approach.”
There are some state variations, but currently under federal law, anyone aged 16 and older can perform any farm job, including agricultural work the Department of Labor considers hazardous and can do so at any time, including during school hours. Children of 14 and older can be employed outside of school hours for any agricultural work except those jobs DOL considers hazardous, while children 12 and older can work outside of school hours if they have written parental consent and 13 year olds can work without written permission on farms where their parents or guardians also work. Children 12 and younger can be legally employed outside school hours with parental consent on farms exempt from federal minimum wage provisions – that is, small farms. However, children of any age can work if employed by a parent or guardian on farms owned or operated by those adults. The hazardous agricultural jobs prohibitions do not apply to children working on farms owned or operated by their parents. The proposed rule would have strengthened hazardous agricultural work provisions for 14 and 15 year olds and created new Hazardous Occupation Orders for those under 18.
When DOL abruptly withdrew the proposed rule in April 2012 it announced that: “Instead, the Departments of Labor and Agriculture will work with rural stakeholders — such as the American Farm Bureau Federation, the National Farmers Union, the Future Farmers of America, and 4-H — to develop an educational program to reduce accidents to young workers and promote safer agricultural working practices.” So I set out to find out how this announced program is progressing.
No safety training required for children and teens working in agriculture
First, it helps to know that there are currently no nationwide requirements for safety training or education for young people working in agriculture. Any training is provided entirely voluntarily. “Under the law there are no federal mandatory requirements for training” young people who are hired to work in agriculture, explained American Farm Bureau Director of Congressional Relations, Kristi Boswell. “There is no required training or education at this point,” said Aida Balsano, a National Program Leader with the US Department of Agriculture’s (USDA) National Institute of Food and Agriculture. But there are, she said, “lots of resources available.”
What I learned from the American Farm Bureau, National Farmers Union and USDA is that following the Obama Administration’s withdrawal of its proposed rule on children working in agriculture, these and other stakeholders began working through the Safety for Youth in Agriculture program (SAY) to identify existing safety training and other educations materials that could become part of a national curriculum. In September 2013, USDA announced award of a $600,000 grant to Pennsylvania State University to “develop a national training curriculum that lessens agricultural hazards to young workers.”
When ready, “Curriculum materials will be placed on the eXtension website in the new Ag Safety and Health Community of Practice to be used in both formal and non-formal settings,” wrote USDA. Also on the agenda is “a national outreach strategy to promote use of the curriculum” and a clearinghouse for “national youth farm safety and education curriculum, state certification requirements and testing.” The first phase of the project is expected to be completed this fall. The draft curriculum materials will be presented at a National Youth Safety Symposium taking place in Louisville, Kentucky on October 27 and 28, where additional input will be gathered from program stakeholders.
At the same time, explained Balsano, project collaborators CareerSafe and Ohio State University are working to develop a 10-hour course that will meet Occupational Safety and Health Administration (OSHA) approval and be applicable to agricultural workplaces. “By late August or early September of 2015 we anticipate having a final rubric for evaluating programs; existing identified training programs evaluated; and an agreed upon training for teachers and credentialing for youth from USDA and DOL,” wrote Balsano in a follow-up email. (CareerSafe is a private company owned by K2Share. No staff is listed by name on the CareerSafe website. Only contact is via email or call centers.) “The ultimate goal is to have youth pass a program that is recognized by OSHA and USDA. The educator would be able to provide youth who participate and pass their training with a certification card of completion which will have the USDA and DOL (OSHA) logos,” wrote Balsano.
Children in agriculture: 38 injuries per day – 115 deaths per year
Meanwhile, the National Institute for Occupational Safety and Health (NIOSH) estimates that 955,000 youth under age 20 lived on farms in 2012. Just under 50% of these young people were reported to be performing farm work. In addition to the 472,000 children living on farms doing farm work, an additional 259,000 youth were hired to work on US farms in 2012 bringing the total estimated number of young people working on farms to approximately 731,000.
NIOSH estimates that slightly more than 100 youth die annually from farm related injuries while more than 15,000 sustain farm-related injuries. According to NIOSH, leading causes of these fatal injuries involved machinery – including tractors, motor vehicles – including ATVs and drowning. While non-fatal injury rates have declined significantly since 1998, the National Children’s Center for Agricultural Health and Safety estimates that they are increasing among children under age 10. The Center also estimates that on average, 38 children per day suffer farm-related injuries.
This is the context in which the Obama Administration withdrew a proposed rule that would have strengthened safety requirements for young people and children working in agriculture – and in which there are currently no national safety training requirements.
Elizabeth Grossman is the author of Chasing Molecules: Poisonous Products, Human Health, and the Promise of Green Chemistry, High Tech Trash: Digital Devices, Hidden Toxics, and Human Health, and other books. Her work has appeared in a variety of publications including Scientific American, Yale e360, Environmental Health Perspectives, Mother Jones, Ensia, The Washington Post, Salon and The Nation.
A recent study has uncovered another possible risk factor for the development of type 2 diabetes: working long hours in low-paying jobs.
In a study published this week in the Lancet Diabetes & Endocrinology, researchers found that people who work more than 55 hours per week performing manual work or other low socioeconomic status jobs face a 30 percent greater risk of developing type 2 diabetes when compared to those working between 35 and 40 hours per week. The association remained even after researchers accounted for risk factors such as smoking, physical activity levels, age, sex and obesity as well as after they excluded shift work, which has already been shown to increase type 2 diabetes risk. The study is the largest so far to examine the link between long working hours and type 2 diabetes.
To conduct the study, researchers examined data from 23 studies involving more than 222,000 men and women in the U.S., Europe, Japan and Australia who were followed for an average of more than seven years. While on the surface, researchers found a similar type 2 diabetes risk among those who worked more than 55 hours per week and those working a more standard 35-40 hour week, more in-depth analysis revealed that workers in low socioeconomic jobs did, indeed, face a significantly higher risk. In other words, the association between long work hours and higher type 2 diabetes risk was only apparent among low-income groups. In a related commentary published in the same journal issue, authors Orfeu Buxton, a lecturer at Harvard Medical School, and Cassandra Okechukwu, an assistant professor with the Harvard School of Public Health, write:
(Study lead author Mika) Kivimaki and colleagues’ finding of an association only in the low socioeconomic status group suggests a possible role of sleep as a mediator; both inadequate sleep quality and quantity are strongly predictive of incident type 2 diabetes. A recent study showed that the association between short sleep duration and diabetes can be partly attenuated by inclusion of socioeconomic status. Working more consistent and less disruptive hours might explain the lack of associations for the individuals in the high socioeconomic status group. A related idea is the role of social jet lag — long working hours and short sleep during the weekdays combined with delayed sleep times on the weekend — that disrupts the circadian timing system and adversely affects metabolism. Laboratory studies have identified mechanisms by which disruption of the circadian system increases the risk of diabetes. Night work, a cause of circadian disruption, is also associated with higher risks of type 2 diabetes.
The study’s authors discussed three possible ways in which working longer hours could manifest into such a significant health risk for low-income workers. The first is that long work hours among low-income workers may be a marker of personal hardships and reflect other confounding variables, while workers with a high socioeconomic status do not experience such hardships and so working longer hours is not hazardous. The second hypothesis is that working longer hours may leave low-income workers with little time to engage in health-protective behaviors, such as getting enough sleep, exercising and socializing. The third possibility is that working longer hours is simply dangerous to a person’s health, but the authors write that “the fact that we do not see (the same health risks among workers with high socioeconomic status) suggests that the association is driven by confounding or indirect effects on other risk factors.”
Still, the study raises the question of whether work conditions should be considered in efforts to prevent diabetes. Globally, more than 285 million people have type 2 diabetes and that burden is expected to grow to 439 million by 2030. In the U.S. alone, more than 25 million people have diabetes and if trends continue, one in three U.S. adults will be living with the costly chronic disease by 2050.
To read the full study, visit the Lancet.
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.
Treatment, Not Prison: Reforming Sentences for Low-Level Crimes Will Boost Health and Safety for All Californians
By Kim Gilhuly
Reforming California’s sentences for low-level crimes would alleviate prison and jail overcrowding, make communities safer, strengthen families, and shift resources from imprisoning people to treating them for the addictions and mental health problems at the root of many crimes, according to a study by Human Impact Partners.
Rehabilitating Corrections in California, a Health Impact Assessment of reforms proposed by a state ballot initiative, predicts the changes would reduce crime, recidivism, and racial inequities in sentencing, while saving the state and its counties $600 million to $900 million a year – but only if treatment and rehabilitation programs are fully funded and implemented properly.
Human Impact Partners conducted an in-depth assessment of the public health and equity impacts of reclassifying six non-serious offenses – crimes of drug possession and petty theft – to misdemeanors. The Safe Neighborhoods and Schools Act, Proposition 47 on the November 2014 state ballot, would also allow people currently in prison for those crimes to apply for reduced sentences and possible release, if deemed eligible by a judge, and redirect savings from the reduction in the prison population to mental health and substance abuse programs, truancy and dropout prevention, and services for victims of violent crime.
If Proposition 47 passes, California would become the latest state to embrace the idea that prisons should be reserved for those who commit serious crimes – not those whose non-violent, non-sexual offenses stem from addictions and mental health problems. Perhaps surprisingly, many of those are so-called red states known more for conservative politics than “progressive” public policy.
Since 2003 Texas, Georgia, Kentucky, Mississippi, Missouri, Oklahoma, Ohio and Pennsylvania have all enacted similar reforms. No less a conservative icon than former House Speaker Newt Gingrich recently wrote in the Los Angeles Times: “It makes no sense to send nonserious, nonviolent offenders to a place filled with hardened criminals and a poor record of rehabilitation — and still expect them to come out better than they went in.”
Looking at corrections through a public health lens starts with the fact that fundamentally, prison is not a healthy environment. Every day, conditions in California’s dangerously overcrowded prisons and jails causes physical and mental harm to thousands of incarcerated men and women. Many of these people were convicted of crimes that pose no serious threat to others, but can be traced to their own substance abuse and mental health problem. We’d all be better off if they were given treatment and held accountable in their own communities, instead of being sent to prison.
A shift in how we charge and sentence people who have committed non-serious, non-violent, and non-sexual crimes has far-reaching implications for the health and well-being not only of those who commit those offenses, but of their families, their communities, and the public. HIP’s assessment found that full implementation of the Safe Neighborhoods and Schools Act would:
- Decrease state corrections spending by $200 million to $300 million a year and county corrections spending by $400 million to $600 million a year. It would increase state funding for mental health and substance abuse programs, school truancy prevention, and victim services by $200 million to $300 million a year.
- Reduce the number of people convicted of felonies by more than 40,000 a year, and the number sentenced to prison by more than 3,000 a year. It would also allow more than 9,000 people now in prison for felonies for low-level crimes to apply for reduced sentence and release.
- Provide mental- health and substance-abuse treatment to those leaving prison, to help position them for success and reduce the likelihood that they will commit additional crimes.
- Reduce the rates of incarceration of African-Americans and Hispanics, who are more likely than whites to be sentenced to prison, county jail, or probation for low-level crimes. African-Americans are only 7% of California’s population, but they represent almost one-fourth of prison admissions. Hispanics are arrested and imprisoned at slightly higher rates than their share of the population, and are 60% more likely than whites to be jailed.
“Evidence is overwhelming that providing treatment to offenders who have substance abuse problems or mental illnesses reduces crime and recidivism,” said Rajiv Bhatia, M.D., former environmental health director for the City and County of San Francisco. “Treatment instead of prison not only benefits their health and well-being, but that of their families and the entire community.”
According to the study, the benefits of sentencing reform would reach far beyond prison walls.
- Almost 4,900 parents in prison, currently separated from more than 10,000 children, could apply for release and return to their families or serve their sentences in a county jail closer to home.
- More than 40,000 people a year would avoid the additional punishments of a felony conviction – restricted access to jobs, housing, voting and other benefits – and tens of thousands could have their felony records cleared, making it easier for them to access the resources they need and not commit additional crimes.
- Truancy and dropout prevention programs keep children in school, greatly reducing the chance that they will run afoul of the justice system. A 10% increase in California’s high school graduation rate could lead to a 20% decrease in violent crime.
- A statewide network of trauma recovery centers will help 12,000 to 18,000 people a year heal from the physical and emotional impacts of being a victim of violent crime.
(Kim Gilhuly, MPH, is a program director at Human Impact Partners, an Oakland, Calif., nonprofit that studies the health and equity impacts of public policy. Neither HIP nor funders of the study are endorsing Proposition 47.)
A little over 70 miles off the coast of New England, an unusual undersea mountain range, known as Cashes Ledge, rises from the seabed. Regulators are contemplating lifting a 12-year-old ban on commercial groundfishing in some parts of this area, sparking a roiling debate. What's not in question, however, is that the highest peak in the range, Ammen Rock, teems with kelp forests, sea sponges, and a wide variety of fish and mollusks — much of it captured by ocean photographer Brian Skerry during dives made earlier this year.
View the gallery.
by Michael Lax, MD, MPH
The news that almost one third of NFL football players can expect to suffer the effects of brain trauma made headlines in major media. While it is not surprising that large men, often leading with their heads, bashing each other week after week suffer some consequences, what was unexpected was how many players are likely to be injured, and that the NFL actually acknowledged this reality.
Obviously, the findings lead to the question of what to do about it besides compensate the injured. In the context of workplace injuries the injury rate in this industry is tremendously high and the severity of the resulting health conditions, including life altering and shortening conditions such as Alzheimer’s disease, chronic traumatic encephalopathy, and Parkinson’s disease should raise serious alarm bells and initiate efforts to reduce the injury rate.
A major question is whether players can really be protected from head trauma given the way the game is played and the personal protective equipment that is available. The League put administrative controls in place a year or two ago, trying to limit certain types of contact to avoid butting heads, but injuries continue to occur. Helmets, the primary protective gear are technologically limited and cannot be designed to really protect the brain from serious trauma. Professional football is an example of work that cannot be made safe, at least without fundamentally altering the way the game is played.
As might be expected, some (many?) voices are calling for the game to be banned, and parents are being urged not to let their kids play tackle football. Others are defending the game and a common argument the defenders use is that professional football players are highly paid and knew the risks going in. They freely chose to take the risk, and others should not be denied from making the same choice.
Our freedom to choose in all areas of life is an idea that is American as apple pie. But the idea of “choice” requires closer examination. Although we like to think of ourselves as individuals who are capable of objectively analyzing every situation and making choices through our reasoning ability, the reality is that our choices occur in a context. That context allows us to see some things and not others, filtering our reason through personal experience, emotional response and who knows what other influences.
To illustrate: how does an NFL football player “choose” to become an NFL football player? To be an NFL player is to join the ranks of an elite group who enjoy all the perks of being a celebrity: fame, fortune, prestige, admiration. If a kid is big and talented, dreams of an NFL future can be stoked early on and nurtured through a long march through high school and college. Other less glamorous possibilities pale in comparison, especially for kids who don’t see other avenues for themselves, or without a scholarship wouldn’t be going to college. Dazzled by the promise of such a glamorous future, how likely is it that a kid is going to listen to the statistics regarding head injuries and future health problems and make a decision to seek some other less traumatic, and much less exciting career path? In this context can a young person ever really be said to ‘understand’ the risks? He is too busy trying to rationalize the risk away because that NFL future is just too hard to let go of.
NFL football is a multi billion dollar business and the owners, team employees, uniform and equipment manufacturers, merchandise makers and sellers, stadium food vendors, sports media, cities collecting tax and other revenue, and the rest of the massive enterprise are all depending on the continuing popularity of the game to keep the money and profits flowing. Toward this end, the product has to continue to satisfy the audience, which has come to expect the excitement of tough men hitting each other as hard as they can. Maximizing the violence, maximizes the excitement and maximizes revenue.
In this enterprise, the players are simultaneously central and peripheral. Obviously the players make the game what it is and star players are celebrated endlessly. But once a player gets old and loses a step, or gets injured they are unceremoniously dumped in favor of someone else who will get the job done better. The game depends upon a continuous pipeline of fresh young players to replenish the ranks thinned by those cast aside. The point is that professional football is not only responsible for ignoring the epidemic of head injuries for so long, but also for painting the picture and creating the system that entices young people into the pipeline, knowing full well that the dream is unachievable for the vast majority who try, and that many will suffer head injuries along the way, often long before they even get close to the NFL. Untold numbers of young people, their lives altered forever, are unmentioned by the NFL’s late epiphany.
The result is an as yet unknown number of high schoolers, college players, and professionals suffering the effects of football induced brain trauma. And likely all of them, after they are injured, will lament the ‘choice’ they made to chase the dream.
So what should be done?
Any other industry found to be this hazardous to its workers would probably be shut down. Since that’s not likely to happen (though maybe a player should file an OSHA complaint and see what happens), other actions are possible. First would be an aggressive campaign to reduce the legitimacy of NFL football as a sport, and to characterize it for what it really is, gladiatorial combat to entertain the masses. Parents might think long and hard before giving permission for their kids to participate, communities might pressure their schools to get rid of their football programs, and people could stop going to NFL games. This would have to be coupled with efforts that are serious and effective in opening up other avenues to fame and fortune, or at least a decent living, for kids who otherwise might see chasing the NFL dream as their only way out of poverty and what they see as dead end lives.
Michael Lax, MD, MPH is medical director of the Occupational Health Clinic Centers and based in Syracuse, NY.
These satellite images, taken from July 1984 through May 2011, reveal the development of the Athabasca oil sands, commonly called "tar sands," which lie at the heart of Alberta’s oil deposits. Tar sands mining, which has become a significant issue for environmentalists, has been rapid and extensive, growing to cover nearly 260 square miles of the Canadian province by 2011. Nearly 2 million barrels of oil are produced every day, according to the Alberta government, with production expected to grow to nearly 4 million barrels per day over the next decade.
View the images.
Last week, an Institute of Medicine panel released a report that critiques US handling of end-of-life healthcare and suggests improvements. Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life recommends improved communication between patients and providers so that patients can decide what kind of end-of-life care they want, and then receive it. Many people would prefer to die at home, with their care focused on making them comfortable — not in a hospital undergoing tests and procedures that might prolong their life but diminish the quality of their remaining time. Under our current system, the latter option tends to be the default, rather than one of multiple options from which patients can select.
The New York Times’ Pam Belluck highlights some of the IOM recommendations that can be accomplished with and without legislation — and the difficulty of getting any relevant laws passed in the current political environment:
Many of the report’s recommendations could be accomplished without legislation. For example, the panel urged insurers to reimburse health care providers for conversations with patients on advance care planning. Medicare, which covers 50 million Americans and whose members account for about 80 percent of deaths each year, is considering doing just that, prompted by a recent request from the American Medical Association. Some private insurers are already covering such conversations, and many more would if Medicare did.
But some recommendations — like changing the reimbursement structure so that Medicare would pay for home health services instead of emphasizing hospital care, and so that Medicaid would provide better coverage of long-term care for the frail elderly — would require congressional action.
“We know that there may be a need for new legislation to be introduced to accomplish that, and we recognize that that’s harder to accomplish in a politically charged environment,” said Dr. Philip A. Pizzo, a former dean of the Stanford University School of Medicine and the committee’s other chairman.
Regardless of insurer coverage decisions, we should all be having conversations with our loved ones about how we’d like to die, and what kinds of criteria we each want to use for decisions about life-prolonging interventions. In a 2010 New Yorker piece on end-of-life care, Atul Gawande gives the example of a patient who told his daughter, “Well, if I’m able to eat chocolate ice cream and watch football on TV, then I’m willing to stay alive. I’m willing to go through a lot of pain if I have a shot at that.” We each have our own preferences, but in order for those preferences to be honored, we have to articulate them, preferably to both our family members and our physicians.
Ezekiel Emanuel, director of the Clinical Bioethics Department at the US National Institutes of Health, shares his personal criteria in The Atlantic, in a provocative piece entitled “Why I Hope to Die at 75.” He states up front that he does not advocate for the free availability of euthanasia, and repeatedly emphasizes that this is his own personal preference, rather than a prescription for the US population. What he intends to do, he explains, is stop receiving several kinds of healthcare once he reaches age 75, and leave himself open to dying from cancer, pneumonia, flu, or another such disease. I imagine most people will have different views about how long they want to live, but it’s an interesting way to start individual and national conversations that we need to be having.