A blow against food fraud in Bangladesh

Turmeric producers in South Asia widely apply lead chromate to the spice to improve its appearance. But Bangladesh is now an exception, according to a report in Undark. After Stanford University researchers showed turmeric consumption was causing high levels of lead in pregnant Bengali women and their children, the Bangladesh Food Safety Authority took action. It raided a major market in 2019, fined traders with lead-tainted turmeric, and simultaneously launched a campaign warning of the dangers of consuming tainted turmeric. Experts say similar strategies could improve public health in India and Pakistan. 

The trust factor

Home visits by community health workers who shared the racial, ethnic, or linguistic background of their pregnant patients—and thus were more likely better able to foster trust—improved pre- and post-natal care, according to a new study in JAMA Pediatrics. The study looked at Medicaid-eligible expectant parents in a home visit program in Michigan. Black mothers gained the most, with a 6 percent drop in their risk of pre- and very-pre-term birth—a small but statistically significant number.

School-based group counseling can boost girls’ mental health

High school girls who attended a four-month, school-based group counseling program in Chicago during the 2017-2018 school year saw a 22 percent reduction in the frequency and severity of symptoms of post-traumatic stress disorder, according to a new study in Science Advances. Rates of anxiety dropped nearly 10 percent, and depression dropped 14 percent.

Jimmy Carter’s crusade against Guinea worm

The former president devoted more than 40 years to global health and human rights initiatives. “I would like to see Guinea worm completely eradicated before I die,” he once said.

Forty years ago, there were  3.5 million cases of Guinea worm worldwide. Last year,  only 13 cases were recorded in humans.

Driving under diesel’s influence

Prolonged exposure to diesel exhaust—already believed to cause 8,800 premature deaths annually in the U.S.—may also lead to decreased brain function, impairing reaction times. Researchers at the University of British Columbia exposed 25 healthy adults to two hours of diesel exhaust and two hours of filtered air at different times. Functional magnetic resonance imaging neural scans, captured before and after each visit, revealed that cerebral regions active when people are at rest briefly changed after exposure to the fumes, which slowed reaction times by fractions of a second. On a population level, the researchers say, prolonged diesel exposure could lead to more accidents and fatalities. This is believed to be the first evidence of traffic-derived air pollution’s impact on brain function in a controlled human experiment.

Food as medicine in the fight to stop tuberculosis

Researchers have long thought of good nutrition as a weapon against tuberculosis, but India’s RATIONS study—an acronym for Reducing Activation of Tuberculosis by Improvement of Nutritional Status—is the first cluster-randomized trial to examine the relationship. According to The Lancet, randomly selected households with a TB-infected person received food baskets for all residents; incidence of the disease in these households dropped by approximately 40 percent.

What’s in your glass?

Nearly half of all U.S. tap water likely contains one or more “forever chemicals,” according to a new study from the U.S. Geological Survey. Per- and polyfluoroalkyl substances, or PFAS, as they are known, are found in everything from pizza boxes to nonstick cookware to dental floss to fire-fighting foam, and they leach into drinking water over time. PFAS have been linked to an increased risk of some cancers and obesity, and to reduced immune responses, among other health concerns.

“Disgusting black sludge” in the U.S. water supply

In other water-related public health news, industry groups have long lobbied the federal government to downplay the risk of manganese, a toxic drinking water contaminant, according to an investigative report from the nonprofit newsroom Public Health Watch. Experts say Environmental Protection Agency safety standards for manganese are influenced by industry-backed research, and that manganese toxicity is linked to developmental and behavioral disorders in children. Lack of regulation and monitoring means manganese may pose a broader threat to U.S. drinking water than previously understood.

The Message, for public health

Hip hop turned 50 earlier this year, and tributes included the public health contributions of pioneering hip-hop artist Doug E. Fresh. He joined forces with Columbia University neurologist Olajide Williams in 2006 to create Hip Hop Public Health, a nonprofit health literacy organization that uses hip-hop songs and videos to advance awareness in underserved communities of everything from dental hygiene to colon cancer screening to managing asthma.

Its musical model is working. A number of studies have found its songs and related K-12 curricula improve awareness and literacy. A 2018 study measured the effects of its stroke preparedness curriculum, which included stroke-awareness hip-hop songs, such as Stroke Ain’t No Joke; a short cartoon; and a video game, among other resources. At the start of the program, two percent of students could demonstrate stroke preparedness; after finishing the three-hour curriculum, that number rose to 57 percent. (Students in the control group showed no change in stroke preparedness.) And 24 percent of the students who took the module retained key information three months later. Hip Hop Public Health has created more than 200 multimedia educational resources and contributes to numerous public health campaigns.

For more public health news, read the rest of our Fall 2023 issue.

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Common levels of traffic-driven air pollution can impair memory and attention after only two hours of exposure, according to a recent study by researchers from the University of British Columbia and University of Victoria. The study is the first controlled experiment to demonstrate that air pollution temporarily alters human brain function. Residents of cities with high levels of air and traffic pollution—such as Delhi, India and Chengdu, China—face the most significant health risks.

India, meanwhile, must grapple with another layer of pollution, with air fouled not only by motor vehicles and industrial production but also by household emissions. Exposure to pollutants inside homes can be up to 13 times higher than outdoor exposure in India, leading to higher rates of acute and chronic respiratory problems across the country. These findings strengthen the evidence on air pollution’s adverse health effects and the need for greater emissions control.

Firearm violence soars amid COVID-19

The U.S. firearm homicide rate increased by almost 35 percent during the COVID-19 pandemic, marking the highest level of firearm-related deaths since 1994. A March report from the Centers for Disease Control and Prevention (CDC) found that this surge also widened existing disparities in gun deaths by race, ethnicity, and poverty level. To curb firearm-related homicides and suicides, the CDC report highlights the effectiveness of hospital-based interventions, whereby trained providers establish relationships with patients while they are still in the hospital. This allows them to connect patients with wraparound services and dissuade them from retaliating against anyone who may have played a role in their injuries.

U.S. life expectancy still dropping

COVID-19 knocked months off expected lifespans globally in 2020, but by the end of 2021 most rich countries had rebounded. Longevity leader Japan did see a dip, but nothing like the U.S., where life expectancy fell to a level last seen in 1996.

Sending mental illness to the bench

A pioneering mental health program in Zimbabwe trains grandmothers to provide problem-solving therapy. Dixon Chibanda, a psychiatrist, founded “The Friendship Bench” to connect community elders with people struggling with common mental disorders such as anxiety and depression. The program, developed in partnership with Zimbabwe’s Ministry of Health and Child Care and the University of Zimbabwe, aims to foster a sense of belonging among patients and empower them to develop practical problem-solving skills and self-confidence. Counseling sessions take place on simple, accessible park benches. The program now serves 60,000 people in Zimbabwe and is being piloted in several other countries, including Vietnam and Kenya.

Help wanted

Work was challenging for everyone during the worst of the pandemic, but public health workers may have experienced more hardship than most. More than one-third of public health workers reported being threatened, harassed, or experienced other negative treatment between the start of the pandemic in March 2020 and the spring of 2021, according to a study by the National Institute for Occupational Safety & Health. That may explain why nearly half—46 percent—of public health workers left their jobs between 2017 and 2021. More than three-quarters of workers who’d been in the field for less than five years quit.

Sexually transmitted diseases increase

After a drop in 2020, the U.S.’s more than 2.5 million reported cases of chlamydia, syphilis, and gonorrhea in 2021 nearly matched 2019’s record high.

Schools vs. social media

School districts are suing social media companies for harming student mental health, including districts in tech centers such as Seattle and Silicon Valley. In January 2023, Seattle’s schools sued the backers of TikTok, Facebook, Instagram, YouTube, and Snapchat for creating a public nuisance by worsening mental health and increasing behavioral disorders. In March, the board of education in San Mateo County, California, in the heart of Silicon Valley, sued Snapchat, TikTok, and YouTube for knowingly building addictive products, and compared them to tobacco companies. School districts in New Jersey and suburban Philadelphia have filed similar suits since the start of the year.

AIR POLLUTION: pixelfusion3d / i Stock; FIREARMS: Illustration by Mary Delaware; BENCH: Constantine Juta; RESUME: mstahlphoto / iStock; SOCIAL MEDIA: pressureUA / iStock

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Health care and its costs should be a top concern for the new Congress, a Kaiser Family Foundation tracking poll found in December, as respondents cited them more than any other issue outside the economy and inflation. More transparent pricing and better mental health insurance topped priority lists.

A relief plan for the Salton Sea in California

The Interior Department in November said it would put $250 million toward cleaning up one of California’s biggest public health problems: the Salton Sea. The vast inland lake southeast of Los Angeles has for decades been sustained by run-off from area farms, but improved water management and drought are causing it to shrink. The resultant dust emissions have been linked to significantly higher rates of asthma than in other parts of California, and raised concerns about other ill health effects from particulates created by long-term agricultural run-off. Research published in Science of the Total Environment in February suggested the Salton Sea and other terminal lakes—bodies of water with no outlets—may increasingly become public health threats due to drought conditions created by climate change. The Interior Department’s four-year funding plan is tied to water conservation efforts and is meant to amplify the state of California’s own 10-year clean-up effort.

KFF Health Tracking Poll Nov./Dec. 2022

Legal marijuana

States with some form of legalized cannabis have seen lower usage by teens and no increase in related disorders such as cognitive issues or mood disorders.

NYC’s first legal ‘safe spaces’ for drug use prevent deaths

New York City sanctioned the country’s first legal “safe consumption spaces” in November 2021, aiming to stop overdose deaths, not drug use. Public health experts say this controversial approach is key to saving lives, especially as fentanyl makes illicit drugs riskier. The centers, run by a non-profit, OnPoint NYC, provide medical care, counseling, and sterile injection equipment, and encourage visitors to use drugs under the supervision of trained staff. In New York, OnPoint said staff intervened to stop 633 overdoses in their first year. Their success could mean more centers opening across the country, a radical change in U.S. policy. But obstacles like regulations, funding, and stigma could block their progress. – Published in Harvard Public Health

Cholera vaccine supply overwhelmed

Beyond the headlines around COVID-19, mpox, and measles, cholera quietly surged in 2022. The number of cholera cases globally is higher than it has have ever been, and cases had been reported in 29 countries through October, significantly higher than the five-year average of fewer than 20 affected countries. Need for vaccines strained global emergency supplies to the point where the World Health Organization in October suspended a requirement for a two-dose regimen for its approved vaccines. Only two companies are approved to produce the cholera vaccines used for global emergency stockpiles, and one of them will cease production in 2023. —Published in Harvard Public Health

Image credits, from top: Mike Cassidy / iStock; Seth Wenig / AP Photo; Bilal Hussein / AP Photo; Michael Conroy / AP Photo

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Baby teeth are impermanent, but they may hold information about childrens’ responses to trauma and could be valuable indicators of future mental health problems. Following earlier work suggesting baby teeth have markings that could be influenced by family exposure to trauma, researchers are looking for New England women who were pregnant at the time of the Boston Marathon bombing in 2013, or who gave birth the year before. Erin Dunn, an associate professor at Massachusetts General Hospital, wants to gather baby teeth from at least 250 children. The study, a collaboration between MGH and the dental researcher Forsyth Institute, began recruiting subjects in 2019, but the pandemic slowed the work and another call was issued in March of this year. The ultimate goal is to determine if screening baby teeth offers a useful public health tool.

“It’s about making sure we have enough tests and vaccines and therapeutics and masks. It’s about vaccinating the world so that we can get this pandemic finally behind us.”

—Ashish Jha on his new role as White House coronavirus response coordinator. _{Today show, March 18, 2022}

198

Rate of deaths per 100,000 women in the U.S. that could have been prevented or treated with timely care, the worst in a group of 11 high-income countries.

The Commonwealth Fund, April 5, 2022

The COVID-19 research boom

The massive effort to detect, fend off, and treat COVID-19 could yield a scientific windfall that will last for decades. For instance, the success of creating mRNA vaccines to fight COVID has prompted a spate of work on applying the vaccine technology to other kinds of illnesses. Kaiser Health News reported that dozens of clinical trials are underway for mRNA vaccines to address pancreatic cancer, colorectal cancer, and melanoma. Researchers are also looking to develop mRNA vaccines for the flu, rabies, and HIV, among other widespread diseases, and for rarer conditions such as cystic fibrosis. Diagnostics tools for a variety of illnesses are also seen as likely. And work on long COVID may open new approaches to treating chronic fatigue syndrome.

“COVID’s ‘Silver Lining’: Research Breakthroughs for Chronic Disease, Cancer, and the Flu,” Kaiser Health News, March 17, 2022

Polio reappears in Africa

A three-year-old girl in Malawi was diagnosed in February as having been afflicted by the virus and is now paralyzed. It’s the first case of wild polio in all of Africa in five years; Malawi has not had a case in 30 years. A single case of paralysis suggests another 200 infections that are less severe or have no symptoms. Officials of the World Health Organization say the strain of polio is one that is active in Pakistan, although it was unclear how it arrived in Malawi. Polio cannot be cured but a full course of vaccines prevents the disease. UNICEF joined an effort to inoculate about 20 million children in Malawi and surrounding nations.

Global dementia cases expected to accelerate

The number of people expected to have dementia in 2050 is projected to hit 152.8 million, up from 57.4 million in 2019. That’s from a study published in The Lancet Public Health in January. The driving factors in the rise of the condition are primarily increases in population and longevity, with the impact varying by region: in sub-Saharan Africa, population growth is expected to be the biggest factor, in Asia, increased longevity. Cases in the United States are expected to almost double, from 5.3 million to 10.5 million.

44%

Drop in cases of dengue fever from 2019 to 2020, thanks to COVID-19 restrictions.

The Lancet, March 2, 2022

Pandemic fallout

While 94% of public health workers and officials employed by state and local governments say their work is important, many are suffering burnout.

“2021 Public Health Interest and Needs Workforce Survey,” Debeaumont.org, March 2022

PTSD screening may reduce reincareration rates

A recent study of parolees on probation diagnosed with a severe mental illness found that they are likely to have also suffered from undiagnosed post-traumatic stress disorder. In fact, 90 percent of probationers with a severe mental illness, such as bipolar disorder or schizophrenia, had also experienced at least one traumatic personal incident, such as physical or sexual assault. After researchers from the University of North Carolina and the University of Missouri studied 207 parolees in North Carolina, they suggested that screening parolees for specific types of PTSD and developing appropriate treatment plans would likely reduce the potential for reincarceration. “Screening for the right types of trauma and experiences can make sure that we are finding the most at-risk folks,” Ashley Givens, an assistant professor at the University of Missouri School of Social Work and the study’s co-author, told Futurity. “It’s important because PTSD is associated with many outcomes that can lead to criminalized behaviors.”

“There is nowhere on earth where the health of millions of people is more under threat than Tigray.”

—Tedros Adhanom Ghebreyesus, WHO director-general, Associated Press, March 16, 2022

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The World Health Organization’s recommendation of a malaria vaccine, after a long and at times faltering development effort, marks a significant milestone. The RTS,S/AS01 (Mosquirix) vaccine, which protects against Plasmodium falciparum, the deadliest malaria parasite, is the first to treat a parasitic disease. Malaria kills nearly a half million people a year, mostly children under five in Africa. Deaths spiked in 2020.

Pilot studies involving more than 800,000 children in Ghana, Kenya, and Malawi showed that RTS,S/AS01 was safe, could be administered through the routine Expanded Programme on Immunization, and was efficacious in preventing hospitalizations from severe malaria. The vaccine, which was developed by GlaxoSmithKline over a 30-year period, requires four doses starting when children are five months old.

Dyann Wirth, chair of the WHO’s Malaria Policy Advisory Group and a professor of infectious diseases at the Harvard Chan School, called the vaccine “groundbreaking” on the radio show Living on Earth. She predicted it will prompt more vaccine development. At least a dozen other potential malaria vaccines are in clinical trials.

HPV vaccines all but eliminate cervical cancer

Cervical cancer could be virtually eliminated if results from a program by Britain’s National Health Service (NHS) can be borne out globally. Between 2008 and 2012, the NHS began vaccinating girls ages 12 to 13 against the human papillomavirus (HPV) with Cervarix, which protects against the virus’s two most virulent versions. A decade later, only five women vaccinated at that age had developed cervical cancer at a rate 87 percent lower than that of women who had not been vaccinated. Women who were vaccinated as slightly older teenagers also had significantly lower rates of cervical cancer as adults. The study, reported in November in The Lancet, is the first to document the impact of vaccination on HPV rates. The health news site STAT noted that low vaccination rates within countries impede elimination of the disease.

1 Patient

seemingly cured of type 1 diabetes after Harvard biologist Doug Melton’s lab turned stem cells into islet cells and developed a potential treatment.

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U.S. Health care’s ill repute

America’s reputation abroad is strong across many societal measures, according to a recent survey of residents of 16 democracies, including Canada as well as states in Asia, Europe, and Oceania. The big exception: health care.

Pew Research Center, Nov, 2021

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40%

Amount of increase, on average, in exposure to cancer-causing industrial air pollution in U.S. Census tracts that are majority-minority versus those with majority-white populations.

ProPublica, November 2, 2021

Data against health racism

New York City’s Board of Health passed a resolution recognizing racism as a public health crisis in October, adding concrete anti-racism efforts to its June 2020 declaration on the issue by the city’s Board of Health. More than 120 U.S. cities have issued similar declarations, according to the American Public Health Association. New York is among the first to spell out steps officials can take to combat historical racism. The Board of Health was called on to perform actions including strengthening several aspects of demographic data gathering. New York’s resolution came on the heels of a separate $50 million program from the Robert Wood Johnson Foundation to transform public health data gathering. Today’s systems “only document racial health disparities without measuring the inequities and racism that fuel them,” Richard Besser, the foundation’s president, wrote in a post on the Centers for Disease Control and Prevention website.

Tampons are a human right, Ann Arbor says

Starting in January, all public restrooms in Ann Arbor, Michigan had to stock free menstrual products, believed to be a first in the United States. Christopher Taylor, mayor of this city of 124,000 about 36 miles west of Detroit, told NPR that “access to menstrual products is a fundamental human necessity.” While other U.S. cities have provided menstrual products in certain locations, Ann Arbor appears to be the first to require that menstrual pads, tampons, soap, paper towels, and toilet paper be available in all public bathrooms, regardless of gender. Failure to comply carries a fine of up to $100. The ordinance was passed unanimously by the Ann Arbor City Council in November, two weeks after Michigan Governor Gretchen Whitmer signed separate legislation making menstrual products tax-free in the state

In debt and in pain

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Credit card debt may be bad for your joints. So found a University of Missouri study that examined the physical health of 50-year-olds with various amounts of unsecured debt, loans not tied to collateral, such as credit card balances and medical debt (the study did not include student loans). Using data from the National Longitudinal Study of Youth, 1979 cohort, researchers found that joint pain for respondents at age 50 corresponded with ratios of unsecured debt to income.

Respondents who consistently had low levels of unsecured debt between ages 28 and 50 had the lowest incidences of joint pain. Both respondents who had paid down debt over time and those who still had high levels of unsecured debt reported more pain and stiffness compared to those with little or no debt. That suggests debt has a cumulative effect on physical health, said Adrianne Frech, an associate professor at Missouri’s School of Health Professions and the study’s lead author. Frech told Forbes that “Both debt and chronic pain can accumulate over time, so this cycle is hard to reverse once it starts.”

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Q: Why are mitochondria important and what do you hope to learn about them?

A: In order for mitochondria to carry out their diverse biochemical reactions, they need to constantly import and export metabolites—nutrients and other substances needed for metabolism. I’m looking at how mitochondria make metabolism efficient, how they adjust according to what our cells need at any point—and how their function can be perturbed in disease.

Mitochondrial metabolism is perturbed in many different diseases, including cancer, diabetes, and diseases of the brain. Cancer cells, for example, proliferate rapidly, so they rely on a constant supply of building blocks and energy that mitochondria play a key role in providing.

We know that there are transporter proteins that allow metabolites to enter and exit through the mitochondrial inner membrane. If we can find ways to target them and modulate their function, then we could potentially change what mitochondria do in diseases.

My lab is also looking at other genes and pathways that we can target to inhibit the growth or alter the behavior of cancer cells. I’m hoping to collaborate with industry to drive the translation of our basic knowledge into something that may ultimately result in new forms of treatment.

Q: You identified two transporter molecules when you were a postdoctoral fellow at the Whitehead Institute. Describe your findings and why they were significant.

A: The first was the mitochondrial serine transporter SFXN1. It’s part of the one-carbon pathway, which is important for a metabolic process known as purine synthesis that provides the building blocks for cancer cells to proliferate. Prior to this finding, we fundamentally did not understand how serine is imported into mitochondria. This is one of the pathways that we may be able to target to treat cancer, but the research is ongoing. There’s always much more to learn.

Another question that I was able to answer was how a molecule called nicotinamide adenine dinucleotide (NAD) gets into mitochondria. NAD is an enzymatic cofactor—basically, a catalyst for respiration and many other metabolic reactions.

I identified the likely transporter as the protein MCART1. It came up in analyses I did using published genetic tools and databases to map the genes involved in mitochondrial respiration. I compared gene essentiality profiles, which are used to measure how important a gene is to a particular cellular process. MCART1 stood out, but its function was previously unknown. So, I was able to build on the knowledge many other scientists have generated before and identify a completely unstudied gene. I connected the dots and was able to find something really important.

Q: You joined the School in October 2020. What was it like trying to set up a new lab during the middle of a pandemic?

A: When people ask me this question, I usually say I don’t have anything to compare it with. This was my first time setting up a lab. It was definitely tough. The School had largely gone remote as a result of the pandemic and there were few people on campus. There was so much to do to set up the lab, like purchasing equipment and figuring out where it all would go, hiring staff, and on top of that, delays, uncertainty, and additional regulations because of COVID-19. I just tried to be patient throughout the process. Now, everything is coming together. I’ve been able to hire a diverse team. Everyone brings unique strengths, and I am excited about the research ahead of us.

Q: What other big research questions do you want to tackle?

A: In the long run, I want to use what we know about mitochondrial transporters and really try to understand more about what happens to different cell types in the brain during diseases like Alzheimer’s and Parkinson’s. In neurodegenerative diseases, the functions of brain cells are compromised. We don’t understand very well
how, but we know that metabolism is one thing that is altered.

I also want to look at what happens in cells when the brain is healthy. The brain uses a lot of energy, and providing it is not a trivial task. That’s where mitochondria are really important.

Q: What excites you about your research?

A: The potential to learn something that will help people—and, ultimately, curiosity. There are so many things that we don’t understand about metabolism and disease. I want to use the tools that I have to contribute to our knowledge in this area. It’s also a way of expressing creativity, by developing new ideas, putting the different pieces we know together, and trying to form the whole picture.

Q: In addition to your scientific work, you’re a mezzo-soprano with the Boston Symphony Orchestra’s Tanglewood Festival Chorus. Do you bring your scientific mind to your singing, or does that tap into a different side of your personality?

A: They are mostly different sides, but they are starting to converge as I am learning to follow my intuition in science more. My voice teacher talks about anatomy, airflow, and coordination of muscles in a very scientific way. It’s helpful to have that training, but when I sing, I try not to think too much, and singing actually helps me shut off the chatter in my brain. During the pandemic, unfortunately, like so many other things, our choir programs were canceled. Instead, I had weekly Skype voice lessons with my teacher. It gave me a lot of stability, because it was one of a few constant things going on in my life during the pandemic and the job transition.

Singing is very tightly connected to your emotional state. So, there were definitely moments during the pandemic when I did not feel like singing at all and couldn’t do it well. But now, I look forward to when our choir activities resume. Singing with other people and an orchestra can be a very spiritual experience. You connect with something greater.

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