Infant mortality down, ailments persist

first_imgThe United States made dramatic health gains during the 20th century, as shown by average life expectancy rocketing from age 48 in 1900 to 77.7 in 2006. Similarly, infant mortality dropped from 47 per 1,000 births in 1940 to 6.7 deaths in 2006.But as those health gains have shifted the health care landscape, a host of new — or newly revealed — issues have emerged concerning the health of the nation’s children. Addressing those issues will require a systematic, system-wide approach, according to José Cordero, dean of the School of Public Health at the University of Puerto Rico.Cordero, who spoke Thursday (March 4) at the Harvard School of Public Health (HSPH), delivered this year’s Yerby Diversity in Public Health Lecture, which brings minority scientists and scholars to Harvard to address health topics. Cordero was introduced by HSPH Dean Julio Frenk and by Alissa Myrick, a research fellow in the HSPH Department of Immunology and Infectious Diseases.In his talk, “Children’s Health: Learning from the Consequences of our Success,” Cordero said that today’s leading cause of child mortality is birth defects, making that area a prime target for intervention.He used the example of neural tube disorders such as spina bifida, where a portion of the spine doesn’t close during development, leaving the spinal cord exposed, and anencephaly, a condition where the brain, skull, and scalp don’t fully form. Research in the 1990s, he said, showed that folic acid given during pregnancy effectively lowered the risk of neural tube disorders. In response, the Food and Drug Administration in 1998 required cereal grain products, such as bread, rolls, rice, and pasta, that are labeled “enriched” to include a minimum level of folic acid.In the years since, he said, neural tube disorders have fallen, but not uniformly among ethnic groups. Hispanic rates, though lower, remain above those for whites and blacks, something traced to the high use of corn flour in Hispanic households. Corn flour in the United States is not typically enriched and so does not include folic acid supplements.While public health officials work with industry and regulators to change that, Cordero said there are other interventions that could help. One is to have providers recommend that pregnant women take folic acid supplements. He cited a survey exploring public knowledge versus action with relation to folic acid and said surveys showed that knowledge of the potential beneficial effects of folic acid rose considerably between 1997 and 2006, but that public action, such as taking supplements, increased only slightly.In exploring that discrepancy, researchers found that many said they would take folic acid if recommended by their doctors, but only 30 to 40 percent of providers actually make that recommendation. Cordero said that points to more interventions with physicians, reminding them to recommend it to pregnant women.Such system-wide interventions are also seen in other conditions of childhood. Cordero said that children born with Down syndrome present another instance where system-wide changes are needed. As recently as the 1970s, he said, children born with the syndrome weren’t expected to live past their teens. Advances since then have pushed life expectancy of Down syndrome babies into their 50s. While that is a health care success, he said, it also presents problems, as providers aren’t typically educated about the health needs of mature and older adults with Down syndrome.That highlights a need for education and training that was less pressing decades ago because of the rarity of people with the condition living so long. Care for older people living with Down syndrome now needs to be front and center because decades ago they typically didn’t outlive their care-giving parents.“This is not a child with special needs. This is a person who will have special needs through their lifetime,” Cordero said.Cordero said it makes sense to aim interventions at women of reproductive age to lower rates of a variety of birth defects. The list of potential conditions that could harm a developing fetus is long. He said interventions should seek to curb smoking and alcohol use, to control diabetes and obesity, to be mindful of the effects of prescribed medications, and to take steps to avoid transmission of HIV to babies from their mothers.“Success in the 21st century will require a systems approach … to meet the new needs of the population,” Cordero said. “Sometimes there are consequences of success that are unexpected. We need to monitor them to ensure that [past] success will lead to greater success.”last_img read more

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Donald Trump and the Return of Seditious Libel

first_imgBy Richard Tofel, ProPublicaIn 1733, New York printer John Peter Zenger began publishing the eighth newspaper in the American colonies, and the first willing to venture criticism of the government. The New-York Weekly Journal was the second paper in a city of 10,000 or so people, 1700 of them slaves.As we are reminded in Richard Kluger’s comprehensive new book, “Indelible Ink,” the first full-length account of Zenger’s travails, by 1735, Zenger (and the likely editor of his paper, James Alexander) had so offended Britain’s royal governor of New York and New Jersey, William Cosby, that Cosby brought suit against Zenger for seditious libel—the crime of criticizing the government. Under the law then in effect in Britain and its colonies, truth was not a defense to this charge. The leading legal treatise of the day explained that “since the greater appearance there is of truth in any malicious invective, so much the more provoking it is.” And: “The malicious prosecution of even truth itself cannot… be suffered to interrupt the tranquility of a well-ordered society.” This was deemed especially the case with true attacks on those in power, as they would have “a direct tendency to breed in the people a dislike of their governors and incline them to faction and sedition.”New Yorkers in 1735, though, weren’t buying it. While the jury in the Zenger trial was instructed that the truth of Zenger’s attacks on Cosby was no defense, Zenger’s lawyer argued that it should be, and asked the jury, if they found the stories true, to acquit the printer. This the jury did, striking a dramatic blow against the law of seditious libel, and launching a proud American tradition, ratified in 1791 in the First Amendment, and laid out over the centuries in a range of Supreme Court decisions.For at least the last 30 years, since Chief Justice William Rehnquist acquiesced in the constitutionalization of the law of libel, which has safeguarded the American press for more than a half century, we appeared to have a consensus in this country around our modern system of protections for the value of a free and untrammeled press to the process of self-government.Until now. This year, for the first time since at least Richard Nixon, the leader of one of our major political parties has pledged to limit press freedom by restricting criticism of his prospective rule.But Nixon’s threats were private, revealed only by his own taping system, while Donald Trump’s are very public, loud and clear. And to be fair to Nixon, he never made good on his private threats, and in the one Supreme Court case he argued personally as a lawyer, he seemed to accept modern constitutional protections for libel.In fact, Trump is more hostile to the legal and constitutional rights of the press than any major presidential candidate of the last two centuries. What he proposes is reminiscent of the Alien and Sedition Acts of 1798 championed (to his immortal disgrace) by President John Adams in the last serious attempt to relitigate at the federal level what had seemed resolved in the Zenger case. It is cold comfort—although it may be some warning to Republicans inclined to go along—that Adams was not only defeated for re-election after passage of those laws, but lost the White House to Thomas Jefferson and his close associates James Madison and James Monroe for a quarter of a century, while Adams’ Federalist Party never really recovered.In case you think a comparison of Trump’s goals with Zenger’s opponents or the sponsors of the Alien and Sedition Acts is unfair, a quick review of the record may be in order.Trump has said that most reporters are “absolute dishonest, absolute scum.” He’s said that “I think the media is among the most dishonest groups of people I’ve ever met. They’re terrible.”In February he pledged that “one of the things I’m gonna do if I win, and I hope that I do, and we’re certainly leading, is I’m gonna open up our libel laws so when they write purposely negative and horrible and false articles, we can sue them and win lots of money. We’re gonna open up those libel laws. So that when the New York Times writes a hit piece that is a total disgrace, or when the Washington Post, which is there for other reasons, writes a hit piece, we can sue them and win money rather than have no chance of winning because they’re totally protected. You see, with me, they’re not protected, because I’m not like other people, but I’m not taking money, I’m not taking their money. We’re gonna open up those libel laws, folks, and we’re gonna have people sue you like you never got sued before.”Nor is a threat by Trump to sue for libel an idle one. In 2006 he brought such a suit against a book that asserted he had wildly overstated his wealth. He lost the case on the merits as well as for failure to prove fault. But the Washington Post reported that “Trump said in an interview that he knew he couldn’t win the suit but brought it anyway to make a point. ‘I spent a couple of bucks on legal fees, and they spent a whole lot more. I did it to make [author Tim O’Brien’s] life miserable, which I’m happy about.’” Trump has also sued the Chicago Tribune and comedian Bill Maher, and threatened to sue the New York Times (more than once), ABC, the Daily Beast, Rolling Stone, the Huffington Post, reporter David Cay Johnston, TV host Lawrence O’Donnell and comedian Rosie O’DonnellIn the February rant, Trump also seemed to threaten to force Jeff Bezos to divest himself of the Washington Post, asserting that it had been purchased to obtain political influence, and declaring that such purchases should be forbidden.Asked in June if his stance on the press would continue as president, he said, “Yeah, it is going to be like this… You think I’m gonna change? I’m not going to change.” He repeated his view that “I am going to continue to attack the press. I find the press to be extremely dishonest. I find the political press to be unbelievably dishonest.”In August he tweeted that “It is not ‘freedom of the press’ when newspapers and others are allowed to say and write whatever they want even if it is completely false!”Melania Trump’s libel lawyer (she is suing the Daily Mail in Maryland for a story on her modeling days) is even more specific, saying that New York Times Co. v. Sullivan, the 1964 Supreme Court decision that established modern press protections, should be overruled.Anyone paying attention knows there is a great deal at stake in this election. Freedom of the press in this country may be among those stakes.ProPublica is a Pulitzer Prize-winning investigative newsroom. Sign up for their newsletter. Sign up for our COVID-19 newsletter to stay up-to-date on the latest coronavirus news throughout New York last_img read more

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