About Me

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Policy provokes me to think and write. I currently work in ivory towers inspiring people to engage in their world. I am a student of the human condition and my classroom is the world. I don't need credentials to have an opinion but I've got paper to prove I know a few things about public health, social welfare and economics. I'm coming out of the tower and taking the words to the people and hope you will send some words back at me.

Monday, October 31, 2011

Preventing the health hazards of adolescent sex: Condoms, sex ed, and the HPV vaccine

Today, the topic of the day is HPV. I'll start with the facts, get them out of the way and get on with the rant.

According to the Centers for Disease Control and Prevention, HPV is the most common sexually transmitted disease in the USA with more than 50% of all sexually active people getting the virus at some time in their lives. Almost all cervical cancer is linked to HPV. Most of the time HPV goes away by itself within 2 years and does NOT cause health problems. Some strains of HPV cause cancer if they remain in the body for a long time and there is presently no way of knowing which people will develop cancer or other health problems. All women are at risk of cervical cancer and most cervical cancers occur after age 30. The National Cancer Institute estimates that in 2011, 12, 710 women will get cervical cancer and 4,290 will die of the disease. This works out to 8.1 cases and 2.4 deaths per 100,000 women per year - a fairly rare illness in the USA (but much more common and deadly in the economically developing world).

I have no qualms against preventing deaths and illness but the risk of cervical cancer is very low as is the risk of death from the disease. So we are immunizing a generation for a rare illness that already has a way of prevention (Yes. Condoms don't prevent 100% but neither does the vaccine). The HPV vaccine, with Gardasil (sold by Merck) being the most popular, has been widely marketed as a way of preventing cervical cancer by immunizing against four forms of HPV that cause the disease (as well as genital warts and vaginal cancer). Recommended age range for immunization is ages 9-26.

I have based much of a career on the belief that sex should be a safe and pleasurable activity that occurs between consensual partners. It shouldn't cost us our lives or our fertility or our social status.

But the politics of sex is why I have slowly gotten out of the sex business.

And nowhere is the politics of sex more volatile than in adolescence. (Well, the AIDS business has become less politicized but still a pit of snakes).

I get it. This is a country of prudes. People who like their sex on the sly instead of out in the open. (Thus the ever constant stream of 'scandals' that are just normal sexual behavior but conducted by famous people).

So when the chance to 'prevent cervical cancer' came along in the form of an injection, the pharmas (Merck in particular) were more than happy to talk about the prevention of HPV - a sexually transmitted disease - as a way to prevent cervical cancer. But not much talk of sex even though the early age of immunization - 11 - was closely tied to making sure a girl (and now boys) get their shot before they are exposed to HPV - through sex. (Age 11 is when many medical practitioners recommend it but on the website Gardasil is recommended for children as young as age 9).

So let's get this straight...... It is not okay to talk sexual health to children at age 11. We would not dare give children a condom at age 11, without societal outrage. However it is ok to give them an immunization at age 11 that prevents an STD (before sexual intercourse exposes them to HPV)

Call me paranoid but the safety record of drugs related to my reproductive parts is not the greatest and as these immunizations have not been around for 70+ years (the average length of time the children getting it now will live), perhaps we should use the opportunity (if you still want to be part of the medical experiment) to pass on some information while giving the shot. If we are going to give a shot related to a disease acquired through sexual behaviors then just maybe we could give a little spiel on behaviors that promote sexual health; like abstinence (yes, every sex ed volunteer preaches abstinence, not just religiously conservative ones), sexual pleasure from behaviors that do not require intercourse such as sexting (and whatever happened to hand jobs?), the use of a condom and monogamy (the holy grail of sexual relationships).

The focus on preventing cervical cancer and not a STD is really excellent marketing!!! In fact, it seems noone really wants to talk about the sexual behavior of adolescents. It appears that sooner or later we'll just give shots against gonnorhea, syphillis, chlamydia, and the lot, to spare us the necessary conversations or the necessary healthy behaviors. (Sorta like the stuff that makes you able to eat fat without it making you fat).

Abdicating a conversation for an immunization shows how far this country will go to avoid necessary conversations about sexual behavior. When I taught my 10 year old about condoms, everyone thought it was too young and yet they could not understand why I would not give her the HPV vaccine. Huh??? Isn't my condom talk and the immunization both based on the assumption that she may soon have sexual intercourse? When mothers told me that they do not want to imagine their daughter's having sex so they would not talk to them about sex and then packed them off for their Gardasil shot, my brain got a little fuzzy on the logic.

The shot separates us from the reality of adolescent sex. I live in a state (Washington) where the law says there should be comprehensive sexual education for young people. (But Washington has ex-state attorney and current senator who want to legalize marijuana and we have 2 female senators and 1 female governor - all democrats so it's not exactly the USA:). I find it interesting that elementary school children can learn about their stomachs when they learn about digestion but all the parts just below the stomach get ignored. As if they aren't there.

Here's the deal: almost everyone will have sex sooner or later. Let's acknowledge that, teach everyone how the sexual and reproductive health organs work (even married people need to know this), teach them how to take care of them and protect them and let's see how much the sexually transmitted disease rates would drop, unplanned pregnancy rates would drops (married people have this problem too), infertility would drop (often caused by undiagnosed STDs) and hey, even the abortion rate (lots of married people have these) would drop. And isn't that what everyone wants? (Yes. Lefties don't like abortions either).

So is it too much to ask that before the 11-year old gets the HPV vaccine, they get a sexual health class and some condoms, sign a form that says they understand what the immunization is for and that they received the class and the condoms, and then get their stab in the arm. Now that would be public health done the 'right' way instead of the 'easy' way.

Saturday, October 29, 2011

Dear Missouri, Re: the fetus, the baby and PAID maternity leave

Missouri and Mississippi have decided that they will decide when life begins. Too many US states have god complexes which make them think they have the wisdom (hahahaa!!) to decide when life begins and the authority to decide when it ends. And oh... by the way.... just because the law (of Missouri of all places!) says its so don't make it so.

Of course, this law is about abortion. And whatever the beliefs of the governor or the laws of the state, when a woman in Missouri wants an abortion she will leave the state to get one. Contrary to the belief of many, the decision to have an abortion is a tortuous one that women do not take lightly. That "Oh shit!" moment of a positive pregnancy test is one of the most feared moments in the life of a woman unprepared (emotionally, psychologically and financially) for a child. If this country was more child friendly in its social welfare policies perhaps women would not go through the mental and physical anguish of termination. 

And while they are legislating their way up my vagina, they all may want to work on legislating more men to be the kind of people with whom we would choose to have a child. Get them a job. Charge them when they hit me. And don't make it like climbing Everest for a rape charge to stick.And as for child welfare policy.... where do I start??? 

Well I think I'll start with maternity leave. Yup... right at the beginning. I could go on and on about how many women do not have access to medical care during pregnancy because so many doctors wont take Medicaid but that's another rant for another day. 

Today I am focusing on maternity leave though it's hard to talk about it and not included all the other sanity-provoking policies related to children in this 'advanced' country.

Ok... so now I have a baby. This is the point at which Republicans talk to me about personal responsibility (I'm not responsible enough to decide about my own body but I'm responsible enough for a child. Yeah. Ok. Makes sense. NOT!). And it begins with maternity leave (and it continues so far into the future that I will be provoking enough family policy to keep this blog filled for a long time to come). It seems that once I have this baby the Reps so want me to have, then I am on my own.

Sure there is this Family and Medical Leave Act (FMLA) which throws all kinds of leave into one 3 month pot and god bless ya if your mom gets sick and you have a baby in the same year. Anyway, say it's just me and this baby. And I dont work for one of the top law firms or corporations that are competing for top talent so give them paid maternity leave to attract and retain them. If I'm just a regular working girl, what do I do? I take UNPAID leave. And if I'm just a regular working girl how do I afford to take an unpaid leave when my expenses just increased? (Subsidized childcare is also a topic for a later rant).

A 2004 Harvard study of 168 nations found that 163 had some form of paid maternity leave. The USA was one of the countries, like Papua New Guinea and Lesotho, that did not. The countries who are members of the Organization forEconomic Cooperation and Development (OECD) average 18 weeks of paid leave!!!!

And what really pisses me off is that feminist activists in this country do not want to provoke this policy because they think it makes us stand out as needing different treatment than men. Really???? We grow humans. We incubate them for 9 months. We have the feeding implements that can be their sole nutritional source for more than 6 months. The men did a poke 9 months prior. Who can argue a huge difference and it's time that women acknowledge the difference, own the power in that difference, and demand what we need to take care of the next generation. Our social welfare policies push poor women to work and social norms support middle class and wealthy women to stay home. Taking care of one's own child should not be an economic luxury!!! In fact, it's cheaper to pay a mother to stay home and take care of her child than to pay for subsidized childcare. But it's not just about money, it's about values. (Oh so many rants for later days).

Maternity leave is a key factor in the gender gap in wages and employment and in the ‘family gap’ in income that exists between women with children and women without children. Much of the gender gap (40-50%) in income can be explained by the family gap differential due to marital and parental status among women. 

The absence of paid maternity leave in the USA has been perceived by feminists and public health professionals as anti-woman, anti-child and anti-family because it does not provide income for the woman post-childbirth nor does it support the 6-month breast-feeding recommendations of the American Pediatric Association. 

Not many women can afford to take unpaid leave and the women who work for companies where paid leave is a perk are more likely to be able to afford to take an extended leave. By making work incompatible with motherhood, women are forced to make hard choices between taking care of their children and being in the workforce.

There is no coincidence in the poor health outcomes we have for infants/children in this country. We do not seem to care what happens to them once they are born but spend way too much time worried about them in utero. It's hard to find affordable quality childcare, public schools suck, juvenile justice facilities are full to overflowing, high school graduation rates are low and college costs more than a condo. 

By making work incompatible with motherhood, women are forced to make hard choices between taking care of their children and being in the workforce. And men do not have to make this choice. Leaving the workforce because of motherhood not only reduces our present income but our lifetime income and our pensions and makes us dependent economically on men - which doesn't work out so well for so many women. (Note to self: future rant on child support collection). The price of motherhood need not be so financially challenging. Or as is happening all over the OECD, women will simply choose to opt out of the motherhood game altogether. And that demographic challenge is not one that is easily fixed. Just ask Japan or Germany or any country where the demographic pyramid is scaring the statistics out of any pension administrator.

Doing research on this topic for an economics class on gender and family, it was really hard to find a rationale for the resistance to paid maternity leave in the USA so I'm not sure why we're stuck in some sort of policy dark age (along with universal health care --- oh way too many rants to write). But I thought I'd end on a positive note and give props to a couple companies (among many) that stand out in this area.

Ernst and Young, which in 2010, was listed among the top 10 family friendly companies by Working Mother Research Institute, provides new mothers with 12 weeks paid leave and 10 weeks unpaid leave. Bank ofAmerica, which was also on the top 10, gives a paid leave to either gender of 12 weeks and allows them to take a total of 26 weeks. 

Women, when you're thinking of where to work, maternity leave policy should be part of your background research (but keep it out of the interview:) if you are thinking about having a child. In the meantime, stay away from Missouri and Mississippi.

Thursday, October 27, 2011

What provokes me

The current political climate in the USA and in Europe is enough to provoke anyone to comment (or rant in my case). So I don't feel particularly unique in that context.

But I am more than a bit of a pain in the arse when it comes to talking about policy. Why? Because I tend not to take sides. And when I do, it's not usually consistent with the 'side' I may have taken on another policy. I admit: I do not judge policy through some political lens but rather through the lens of: Does this make sense? Why? And for who?

In a country full of centrists (Democratic Reps and Republican Dems), its a pretty easy thing to go either way. In the USA there is a new group of people that have actually brought some right to what has always been a center game: the tea drinking folks. To make it really fun there needs to be a whacko left to join them. I use the term 'whacko' because despite my sharp brain and that of commentators around the world it's pretty tricky business to make policy sense of the tea party - that brand of republican so 'interesting' they provide political entertainment at a time when the state of the world gives us need of a little laughter inspired by incredulity.

I am tired of 'the left' (which in the USA means 1 mm left of center) making logical arguments about policies that they think will pass. Why not just throw a hail mary? (For those readers not American or football friendly that's 'longshot'). What is so wrong with just 'going for it'? It is not as if the logical stuff is getting through Congress anyway. So if there is a real left out there, perhaps what's on offer by the Dems will look so 'sane' that the Reps will happily give it a vote. Or just perhaps Dems should give a rats ass about what Congress will pass and give the people what they want and then let the Reps take the heat for shutting it down.

Where is the Faux News on the left? (Yes. A whole channel full of ranting lefties of various persuasions). Where are the people willing to propose radical leftie ideas (No! Healthcare for all is not a left idea because even right governments, fascists and dictators accept this as a policy norm). Where are the people willing to say leftie stuff that will have people sit up and take notice. Where is the 'tax party'? The party that promotes more taxes for the rich and for corporations? Are there enough people to follow Warren Buffet's lead?

Occupy Wall Street (and main streets all over the USA) is a populist movement demanding changes in the way banks and corporations operate but perhaps they need to occupy DC. Where lobbyists on K Street suck up cash and hedge their bets on either side. Where interests, special or not, get traded like monopoly game pieces. Occupy DC would hold elected officials responsible for making the choices the people want them to make.

Right now, the USA will have a hard time disengaging from capitalism at its greediest while trying to encourage business to occupy Detroit and shiny up the rust belt. Greed drives growth. Or it did. And we all went along for the ride. A home for everyone and everyone a stock trader. We bought 3 cars, shopped our fill on eBay and bought more stuff at Costco than we could use in a lifetime; or even used at all.

So that's what I'm going to be writing about: stuff that pisses me off and annoys the hell out of me. Policies for poor people that benefit the rich. Policies that have an underlying addition problem that a preschooler would notice. Policies that have goals and objectives not slightly related to their stated outcomes.

Policies like the small government proposals of the Republicans that have their hands so far up my uterus I'm all for them making government quite a bit smaller (at least in that respect) until they stop telling me who I can marry and what to do with my body.

This will be my Faux News channel. I wont make up the data (I've got a professional reputation to uphold) and I will not be careless in my interpretation (my brain just wont let me) but when policy provokes me I shall write and hope that you too get provoked.