A Pop Health Book Review of “In the Kingdom of the Sick: A Social History of Chronic Illness in America”

In 2009 I read "Life Disrupted: Getting Real about Chronic Illness in Your Twenties And Thirties".  Since the book inspired me personally and professionally, I was delighted that Twitter enabled me to connect directly with the author Laurie Edwards.  I was even more delighted when she asked to interview me for her new book, "In the Kingdom of the Sick: A Social History of Chronic Illness in America".  Since Pop Health focuses on health communication and the coverage of public health issues in the media, we had plenty of mutual interests to discuss!

"The very nature of chronic illness- debilitating symptoms, physical side effects of medications, the gradual slowing down as diseases progress- is antithetical to the cult of improvement and enhancement that so permeates pop culture." 
("In the Kingdom of the Sick", page 34)

Early in the book, I found this quote incredibly powerful.  It is true.  Our society values and spotlights those that overcome adversity- those that inspire us- those that beat the odds.  Before his fall from grace, we can all remember the worldwide cheering for Oscar Pistorius- making history last summer for being the first double-amputee to compete in the Olympic games.  Edwards highlights those societal values in her book by drawing on the imagery found in many commercials for breast cancer research and fundraising.  Those commercials show an unforgettable image, a "cancer survivor triumphantly crossing the finish line in her local fund-raising event surrounded by earnest supporters."  That triumphant image is a far cry from what Edwards and colleagues term the "Tired Girls" (i.e., female patients suffering with "invisible illnesses" like fibromyalgia, chronic fatigue syndrome, and migraines).  "The Tired Girl stands for so much that society disdains:  weakness, exhaustion, dependence, unreliability, and the inability to get better" (page 103).

The good news is that many of the "Tired Girls" (and Guys) are getting connected and getting empowered.  Edwards dedicates a significant portion of her book to the discussion of "patients in the digital age."  She describes the emergence of "e-patients" (those that are empowered, engaged, equipped, enabled) and how they are using technology to actively participate in the development of their care plans, connect with patients with similar diagnoses, give voice to their experiences, advocate for policy change, and debate controversial topics like vaccinations.

As a public health professional with significant interest in health communication, I was fascinated by a recurring theme that Edwards highlights from these conversations among empowered patients and writers:

"How does language influence the illness experience?"          

The reader is led through an intriguing discussion of the use and implications of terms such as:

• Illness vs. Disease
• Illness vs. Chronic Condition
• Illness vs. Disability
• Military Metaphors (e.g., "the battle against disease")
• Chronic Pain Patient vs. Patient with Chronic Pain
• Healthy Disabled vs. Unhealthy Disabled
• Patient (does it connote passivity?)

"In the Kingdom of the Sick" is a fascinating read for anyone with a personal and/or professional connection to chronic illness.  It begins by giving you a strong foundation in the history of illness, research, and patient advocacy movements.  It then challenges you to consider the impact of advances in patient rights, science, communication, and technology on the incidence, treatment, and perception of chronic illness.  I highly recommend this book to my Pop Health readers, friends, and colleagues.

If you are interested in connecting with Laurie Edwards:

Website:  http://www.laurieedwardswriter.com

Blog: http://www.laurieedwardswriter.com/blog

Facebook:  http://www.facebook.com/laurieedwardswriter

Twitter:  https://twitter.com/achronicdose 

"Girls" Tackles OCD: What I Hope IS NOT Happening In Our Emergency Departments

This afternoon I had the pleasure of having some downtime- so I used it to catch up on the three recent "Girls" episodes sitting on my DVR.  Having avoided spoilers, I was surprised and saddened to see Hannah (Lena Dunham) being consumed by Obsessive Compulsive Disorder (OCD).  We learn that she had a serious bout with the condition once before- in high school.  It was so serious that she sought professional help and medication at that time.  Flash forward to her post-college life and we see her plagued again...perhaps triggered by the stress of a recent break-up and a looming book deadline.

While there are several disturbing issues in the most recent episode "On All Fours" (you can see the comments in Alan Sepinwall's review for those details), I want to focus specifically on Hannah's trip to the local emergency department (ED).

I was very upset watching this scene and I'll tell you why:

We know that emergency room providers are key gatekeepers for those who are suicidal and/or suffering from mental illness.  Research tells us that 1 in 10 suicides are by people seen in an emergency department within 2 months of dying.  Acknowledging the importance of this gatekeeper role, leadership organizations in suicide prevention have created a variety of toolkits and resources to educate and train emergency department personnel to identify patient warning signs and assess their risk.

In "On All Fours", Hannah visits the ED after obsessively sticking a Q-tip in her ear, getting it stuck, and experiencing pain.  After lying to her parents by saying she has "12-15 good friends" to accompany her to the ED, she goes alone.  The scene opens with the doctor telling her, "Well, you must be feeling pretty silly."

As the doctor examines her injured ear, Hannah says:

"I've just been having a little trouble with my mental state."
"I have a lot of anxiety and I didn't think stress was affecting me but it actually is."
"I'm not saying this was an accident, but I was just trying to clean myself out."

At no point does the doctor respond to any of these statements.  He is all business, telling her to follow-up with a specialist if she is still experiencing pain in a few days.  As Hannah lays down so he can put antibiotic drops in her ear, she pleads with him to look at her other ear.  He snaps at her "there is nothing wrong with the other one."  Hannah cries on the bed because it (the drops? her situation?) hurts so bad.

He discharges her and she walks home alone.  In just a t-shirt and no pants.

Now I'm not saying that Hannah was acutely suicidal or verbalized such a threat in the ED.  However, I am saying that she made several clear statements about her mental health that should have been treated with concern and respect by a competent medical provider.  Her demeanor and her appearance deserved a kind ear, a social worker's visit, someone to ask if she was all right.

These recent episodes have been applauded for their accurate portrayal of OCD.  I hope that a future episode will show a portrayal of a caring and skilled provider using the public health prevention and education tools that are available to assist someone in desperate need of help.

For any readers that may need help:

• The National Suicide Prevention Lifeline:  1800-273-TALK
• Substance Abuse & Mental Health Services Administration: (SAMHSA) Mental Health Treatment Finder

Using Twitter to Track Disease: Weighing the Advantages and Challenges

A few weeks ago I participated in a fantastic twitter chat on the use of social media for public health.  During the event, our moderators posed the following question: "Are there any other diseases (besides the flu) that we could track on social media?"

The question generated a very lively discussion that I was inspired to revisit on Storify this morning after reading the Washington Post's article, "Twitter becomes a tool for tracking flu epidemics and other public health issues." 

The WP article highlights several advantages and challenges of monitoring public health diseases and/or conditions on twitter.  My twitter chat colleagues brought up many other important issues for us to consider, so I'm including these expanded lists:

Advantages:

• Offers real time data on health or behavior (Government data can often take weeks or months to be released)
• There is so much available data! 
• It could capture cases that would not otherwise be formally documented at a physician's office or hospital.
• It has proved helpful in tracking time sensitive disease outbreaks (e.g., Novovirus).  *Check out this article about how twitter was used to track Norovirus activity during a journalism conference.

Challenges:

• Accuracy and case definition (i.e., does a twitter user really have the flu or just a bad cold?)
• Tracking specific words like "sick" or "flu" can bring up a lot of content that is unrelated to the twitter user being ill themselves (e.g., "I'm so sick of this terrible weather").  *Check out how Johns Hopkins researchers are working to address this problem by better screening tweets.
• We must differentiate between tracking symptoms vs. tracking cases- they are not the same.
• Our search strategies should include various terms or slang that are used to describe the disease or behavior of interest.
• Caution: media coverage of certain illnesses can cause a spike in key words on twitter without a rise in actual cases.
• What are the privacy concerns?
• Twitter might not thoroughly capture diseases or conditions that carry stigma (e.g., mental illness) because users may be hesitant to discuss them in a public forum.
• Results could be skewed by populations who are over or under represented on twitter.
• Do we need to train "trackers" to intervene? E.g., what if they are monitoring dangerous tweets/behaviors like suicidal ideation and attempts?

While the challenges list is quite long, I hope we are not discouraged!  I think twitter is an enormous resource for public health professionals.  We just need to be thoughtful and thorough regarding how to use twitter effectively.

More Resources:

The Washington Post article and related stories shared great links to more information about research in this area:

• YouTube video on University of Rochester efforts to track influenza on twitter.  It also describes their related app: Germ Tracker (warning: it may have you hopping off your regular morning bus). 
• Johns Hopkins University article: "You Are What You Tweet: Analyzing Twitter for Public Health".
• Brigham Young University article: "'Right Time, Right Place' Health Communication on Twitter: Value and Accuracy of Location Information".
• A great article that highlights what we can learn from Google Flu (since their predictions were off this year)- emphasizes the importance of "re-calibrating" your models or algorithms each year.

What Do You Think?

• What other advantages and/or challenges should we add to the list?
• What other resources can you share?

  

Downton Abbey: A Mountain of Viewer Tears Leads to an Incredible Online Discussion about Maternal Health

Warning: if the January 27, 2013 episode of Downton is still on your DVR- this post contains spoilers!

From the looks of twitter this week, I am not the only person who was devastated by the loss of Lady Sybil on Downton Abbey.  She died of Eclampsia shortly after giving birth to her daughter.  In my house, there was complete silence while we watched Sybil convulsing and struggling to breathe.  After she died, our horror and sadness quickly turned to anger.  There were two doctors in the room (one of whom made the correct diagnosis)- how could this happen?

As I contemplated this question, I was fascinated to see how this story line impacted the public health messaging that started appearing on twitter.  I recognized a few trends:

Making the connection to current women's health issues and debates

There has been much concern about men making decisions about women's healthcare- for example, the comments in 2012 about the definition of rape and the ongoing abortion debate.  Since Sybil's death was largely the result of poor decisions about her health (made by her father and the fancy male doctor consulting on her case), I saw the following post on this topic over and over again:

 

Identifying a Teachable Moment:  Preeclampsia and Eclampsia Specifically

Like many organizations, the American Public Health Association (APHA) followed up on Monday with this message:

Identifying a Teachable Moment:  Maternal Mortality and Maternal Health Broadly  

I saw many links to organizations such as Every Mother Counts, which focuses on global maternal health advocacy:

In addition to the discussion on social media, many news outlets and foundations also took the opportunity to post information on their websites about the condition that killed Sybil.  For example, ABCNews wrote, "Eclampsia Death in 'Downton Abbey' Highlights Pregnancy's No. 1 Killer".

I would love to see some evaluation data to follow this teachable moment.  Some questions that I have:

• How many people searched for Preeclampsia and Eclampsia following the episode?  (As a side note, this episode aired months ago in the UK- was there a similar searching pattern?)
• How many physicians/midwives/clinicians received inquiries from patients following the episode?
• Beyond knowledge- did this episode change any clinician behaviors?  Did they go back and review a suspicious case after seeing a reminder of the severity of this condition?  Did they perform a more comprehensive screening?

What do you think?

What other evaluation questions should we be asking?

What other trends did you see in the discussion on social media (or in person) following this episode?

Rent The Runway Rocks Real Non-Airbrushed Models: Us!

Like many of you, I have tried ordering clothes online.  And it never goes well.  They are always too tight or too long.  They immediately make you feel bad about yourself.  And of course- it is a huge pain to have to pack it up again and mail it back.  And after all that- you still don't have anything to wear!!  Weird, right?  The clothes looked great in the pictures.

 

The frustration of online shopping is a symptom of a larger problem.  Many fashion lines are not made to fit the average woman.  Rader Programs, a group of  eating disorder treatment facilities, estimates that the average model weighs 117 pounds at 5'll and the average woman weighs 140 pounds at 5'4.  No wonder my purchases are too tight and too long!

 

However, I'm feeling optimistic about change being possible in the fashion world.  As of last week, Rent The Runway, an online service that lets users borrow current season high-fashion, has expanded their  use of real women as models on their site.  Users can upload pictures of themselves in the clothes, and include details about their height, weight, and chest size.  The site will also have the capacity to allow users to search for women of similar body type, so that they can see how the clothes actually fit.  I think this is fantastic.  Not only will it hopefully cut down on the dreaded returns, but women will see models that look like them.  It can reduce the shame and stigma that many women feel for lacking the 117 pounds at 5'll "ideal".

 

This initiative follows what I hope is a pattern of push back on pop culture for upholding women to unrealistic ideals that may lead to unhealthy body image.  For example, we are seeing opposition to magazine airbrushing.  Earlier this year, an ambitious eighth-grader put the pressure on Seventeen Magazine to review its policies on airbrushing and consider the impact it could have on young readers.  Her online petition led the magazine to sign an eight-point "Body Peace Treaty", which outlined a commitment to never change models' body or face shapes. 

 

We are seeing celebrities (especially recently!) disclosing their battles with eating disorders- often discussing the pressure they felt being in the entertainment industry.  Over the past few months, we've heard from Katie Couric, Nicole Scherzinger, and Stacy London.   Last year, Pop Health reviewed Portia De Rossi's book- Unbearable Lightness, which discussed her life-threatening eating disorder in much detail. 

 

I hope that we are continuing to see a shift.  I hope that there is less stigma in disclosing or discussing body image concerns and eating disorders.  I also hope that the public continues to make their voices heard...whether they are fighting the magazine airbrush or the high fashion gown that will look terrible on anyone under 5'10.

 

What do you think:  With the initiatives above and their predecessors (e.g., the Dove Campaign for Real Beauty)- do you see evidence of a shift in pop culture from "thin" to "real women"?  What else needs to change to keep this initiative moving forward?

 

 

 

 

 

 

 

Madonna's "MDNA Show Manifesto" Defends Using Guns on Tour: Do You Agree?

As we speak, Madonna is en route to my city- Philadelphia, to launch the North American leg of her "MDNA World Tour".  In advance of her arrival, she has released a statement to the local Metro defending one of the most controversial parts of her tour...the use of fake firearms in concert.  Here is a portion of that statement:

"It's true there is a lot of violence in the beginning of the show and sometimes the use of fake guns - but they are used as metaphors.  I do not condone violence or the use of guns.  Rather they are symbols of wanting to appear strong and wanting to find a way to stop feelings  that I find hurtful or damaging.   In my case its wanting to stop the lies and hypocrisy of the church,  the intolerance of many narrow minded cultures and societies I have experienced throughout my life and in some cases  the pain I have felt from having my heart broken".

Gun violence is (unfortunately) not a new problem.  However, the topic is quite timely due to increased U.S. media coverage following several mass shootings in the past few weeks- Aurora, CO, Oak Creek, WI, and New York, NY.  The issue of gun violence has reached crisis levels in Philadelphia where Madonna will be performing.  A new open source journalism project called http://guncrisis.org/ "contends that there is an epidemic of homicide by gunfire in Philadelphia and similar cities".  They are seeking solutions.

The solutions being sought by GunCrisis: Philadelphia and others involve taking a public health approach to gun violence.  The recent high profile shootings have produced several well-written pieces about gun violence and what we need to do next:

•  Prompt policy discussions about easy access to ammunition, high-capacity magazines, and assault weapons.
• Use our public health skills to conduct further research into the causes of firearm injuries.
• Examine gun violence as a social disease- one that stems from a society "saturated with guns".

Tell me what you think:

Do you believe that the gun "saturation" goes beyond those in our homes to include those used for entertainment?  E.g., Guns in movies or video games; Madonna's concert props

Is Madonna successful? Does using guns as a metaphorical image help her reach her goals and battle against hypocrisy and intolerance?

In addition to those listed above, what other strategies should we incorporate into a public health approach against gun violence?

Cameron Diaz: The Next Celebrity Nutritionist?

Cameron Diaz is busy with her next project.  Her rep confirms her interest in writing a nutrition book to help young girls.  She wants to use her celebrity for good- to encourage girls not to fixate on being thin but instead just to make healthy choices.

A few thoughts:

Of all the celebrities that I see pitching these types of projects (I'm looking at you Gwyneth Paltrow), Cameron actually seems to model a healthy lifestyle.  She is not too thin, but instead looks muscular and strong.  We always see her keeping active with surfing and regular gym workouts.

It is reported that (in preparation for the book) Cameron will be visiting high schools to talk to teenagers about their food choices and what is important to them.  She wants to get their input, e.g., how do they decide what to eat? Although this work will not be a formal "Needs Assessment", I like that Cameron will be out in the community and talking to the teenagers who are the focus of her book.  Doing formative work before a project that engages your audience is incredibly important in public health.  Hearing and seeing what the health problem/s look like first hand allow us to craft more effective interventions.  So I applaud Cameron for planning to do this outreach versus just planning to write a book that may or may not address the challenges faced out in communities. For example, Cameron can discuss the importance of choosing fruit over potato chips, but if a teenager does not have access to affordable fresh fruit in their neighborhood, then the recommendation is not helpful.

One challenge to this effort is that even though Cameron appears to model a healthy lifestyle, she is still a member of the Hollywood community that has contributed to setting an unrealistic standard for beauty.  We have seen her on numerous magazine covers looking very thin and of course airbrushed.  In public health, we always have to think- "is this the right spokesperson"?  It is important to know how teenage girls view Cameron.  Do they see her as part of the problem?  Or part of the solution?

Another challenge is that (from my perspective), celebrity "nutritionists" do not have the best track record for safety and accuracy.  Take Cameron's friend Gwyneth Paltrow.  She has regularly promoted nutrition strategies like detox cleanses and gluten-free diets.  Her extreme choices do not send a message of moderation to teenage girls.  In addition, Gwyneth's cover photos also contribute to the unrealistic standard for beauty.

As I've discussed many times on this blog, celebrities can be an incredible resource for public health.  They have a visible platform and extensive reach to many of our audiences.  However, that can work for us or against us based on the accuracy and relevancy of their messages.  It is imperative that they work closely with clinicians (e.g., physicians, nutritionists) and public health practitioners to craft the messages and design outreach programs.

What do you think about Cameron writing a nutrition book?

The Biggest Loser: Who's Really Winning?

This week's guest post for Pop Health was written by Elana Premack Sandler, LCSW, MPH.  Elana writes a popular blog for Psychology Today called, "Promoting Hope, Preventing Suicide".  Written from both personal and professional perspectives, her blog explores suicide prevention, intervention, and postvention.  Often using current events as a starting point, the blog poses questions about what could be done better or differently, what contributions research can make to practice, and challenges and opportunities inherent in new technologies.  Elana earned a Master of Social Work and a Master of Public Health at Boston University and is a licensed social worker in the Commonwealth of Massachusetts. 

There’s a lot of TV I don’t watch, but there’s one show in particular. “The Biggest Loser.”



It’s true - I systematically avoid watching one of the most popular reality TV shows in history. What seems to have drawn in viewers is what bothers me so much about most reality TV. It’s like a car wreck you can’t stop staring at, even though you know it’s a tragedy.



But watching a car wreck is watching an accident, something that wasn’t designed for an audience. With an accident, there’s something very human about wanting to see what’s happened, wanting to know if everyone’s okay.



That’s very different from what I think happens when people watch “The Biggest Loser.”



The few times I watched (I kept trying - people I love and trust told me it was such a good show!), I just wasn’t able to get behind the premise of the show. Yes, I believe that people who have struggled to lose weight can benefit from personal training and major lifestyle changes. Sure, the power of competition can drive some people to work harder than they ever imagined possible.



But, shame? Does shame really help people change their behavior?

When I watched, I witnessed trainers shaming contestants, over and over, in different ways. I heard contestants talk about the shame they experienced as a part of being obese or overweight. The whole show was a shame-fest. Which made me extremely uncomfortable.



Because, when it comes down to it, “The Biggest Loser” is a game show. And I just can’t watch people shamed into losing weight just to win a game show.

  “But it’s not just a game show!” my friends-who-are-fans would say. “People change their lives.”

Oh, wait, you’re right. It’s not just a game show. It’s a franchise.



So, I guess what I really have a hard time with is people being shamed into losing weight to support a game show-Wii-resort-1,200 calorie-a-day diet franchise.



At my professional core, as a public health social worker, I know shame doesn’t work to change behavior. I had thought it was just me who thought that way, until I started reading researcher Brené Brown’s book, “I Thought It Was Just Me (but it isn’t): Telling the Truth About Perfectionism, Inadequacy, and Power.”



Brown has been researching shame for the past 10 years. But, even before she was a shame expert, she was a social worker, working with people. What did she learn? “You cannot shame or belittle people into changing their behaviors.”



She explains in the introduction to the book:


• Can you use shame or humiliation to change people or behavior? Yes and no. Yes, you can try. In fact, if you really want to zero in on an exposed vulnerability, you could actually see a swift behavior change. 
• Will the change last? No. 
• Will it hurt? Yes, it’s excruciating. [I cringed when I read that part.] 
• Will it do any damage? Yes, and it has the potential to sear both the person using shame and the person being shamed. [More cringing.]
• Is shame used very often as a way to try to change people? Yes, every minute of every day. 


“The Biggest Loser” gets exactly how to use shame to motivate people to make a “swift behavior change.” Body image - for people struggling with overweight and obesity, and for people at healthy or “normal” weights - is a tremendous source of shame. Obesity is even worse. I wouldn’t be the first to say that oppression - hatred, bullying, and discrimination against - overweight and obese people is one of the last acceptable oppressions in our society.



What’s extra-disturbing about how “The Biggest Loser” uses shame is that it doesn’t limit shame to contestants. The show projects shame into the viewing audience, reinforcing biases against people who are overweight or obese. The audience doesn’t root for contestants to work within the challenges inherent in their bodies to figure out a healthy, sustainable way to lose weight and maintain overall health. The audience roots for contestants to not be fat. (Please excuse my lax grammar- I hope it’s worth making the point.)

Finally, the drama of the show revolves around shame. There’s a big reveal every episode, when viewers find out who won’t continue to compete to be The Biggest Loser. If contestants can’t lose weight within the show’s parameters (which include unhealthy weight loss practices, like dehydration), they get kicked off. So, the ideal of working with a supportive trainer goes out the window - and you are shamed, shamed, shamed into returning home, still fat, and, well, not a winner. A loser.



“The Biggest Loser” raises several questions for me:

• Should a game show be allowed to promote unhealthy weight loss practices?
• What kinds of messages does the show send to young people about their worth and value? 
• In what ways are people at a healthy weight influenced by “The Biggest Loser”? 

But, the most important to consider is this one: How much money is being made off of shame?

Integrating Public Health Content Into Media Coverage of Celebrity DUIs

Amanda Bynes is just the latest young female celebrity to be arrested for driving under the influence (DUI).  The media coverage has been extensive, with some outlets even raising the question, "Is she the next Lindsay Lohan?"  A fellow former child star, Lindsay Lohan has consistently been in the news the past 5 years with DUI arrests, rehab stints, and poor career decisions.  However, just a few weeks ago we heard the good news that she has been taken off probation from her DUI case...so hopefully things are looking up.

Pop Health has written about related issues in the past:  how soon is too soon to find a teachable moment in a celebrity DUI death?  How does popular media help establish the public health agenda? How does media coverage of public health issues (e.g., suicide) affect the public's health?

So now let's put the pieces together and discuss the work of public health researchers that focuses specifically on media coverage of young female celebrity DUIs.  In 2009, Smith, Twum, and Gielen published "Media Coverage of Celebrity DUIs: Teachable Moments or Problematic Social Modeling?" in the journal of Alcohol & Alcoholism.  They conducted an analysis of US media coverage of four female celebrities (Michelle Rodriguez, Paris Hilton, Nicole Richie and Lindsay Lohan).  The study examined media coverage in the year after their DUI arrests (December 2005 through June 2008).  Among other things, the stories were coded for the presence of public health content (e.g., arrest, death, and injury statistics for DUI).  The authors found that the coverage was primarily focused on the individual celebrities (i.e., their legal and professional repercussions) versus broader social or public health impacts.  They recommended that future research examine both the news coverage and the comprehension and use of that content for policy and behavior change initiatives.

Coverage of a celebrity DUI has the potential to be a teachable moment, but we as public health practitioners need to take advantage of it.  We need to be monitoring pop culture news so that these teachable moments can be identified. We need to partner with journalists in order to make sure that a "public health frame" is incorporated in the development of the articles.  Most importantly, we need to continue to evaluate the media content and use that data to develop effective interventions and policy recommendations.

What do you think?

•   What strategies/information channels do you use to stay on top of public health-pop culture news?
•   How can the public health and journalism fields partner to take advantage of teachable moments and cover public health issues safely and effectively?

"E-Lane" for Pedestrians: An April Fools' Day Prank With Real Public Health Implications

Earlier this week, Philadelphians were treated to an April Fools' Day prank courtesy of Mayor Michael Nutter and the city's Office of Transportation and Utilities.  Across the street from city hall, an "E-Lane" was designated for pedestrians who use (and are distracted by) their electronic devices while walking.  While the city only expects to keep the joke "E-Lane" around for a week, they also hope that it starts a dialogue about pedestrian safety and people looking out for themselves while walking around the city.  Since this April Fools' week also happens to coincide with National Public Health Week (a time dedicated to recognizing the contributions and challenges of public health), I thought it was a great story for Pop Health.  So I took a stroll down the "E-Lane" on Monday to take these pictures and to get the dialogue started.

While I have written about (and am a huge supporter of) the vast and ever expanding benefits of mobile devices for public health, I also acknowledge the challenges that they have created.  Even though Philadelphia created the "E-Lane" as a joke, drivers and pedestrians distracted by electronic devices have become a serious issue.   

The Centers for Disease Control and Prevention website on distracted driving tells us that each day, more than 15 people are killed and more than 1,200 people are injured in crashes that were reported to involve a distracted driver. Distracted driving occurs while doing another activity that takes your attention away from driving; these activities can increase the chance of a motor vehicle crash.  While distracted driving can include talking on a cell phone, texting, or eating, texting is most dangerous because it takes your eyes off the road (visual), hands off the wheel (manual), and takes your mind off driving (cognitive).

As with any emerging public health problem, we are beginning to see:

• Research:  papers on distracted drivers and pedestrians are being published in the peer reviewed literature.  
• Education: cautionary tales of distracted driving are emerging in the popular media.  Just in the past few months, the Today Show has hosted several sets of parents who lost children due to texting and driving. 
• Celebrity Spokespeople:  Teen sensation Justin Bieber is partnering with the Remember Alex Brown Foundation and Phone Guard's Drive Safe.ly application to promote responsible texting.  The application reads text (SMS) messages and emails aloud in real time and automatically responds without drivers touching the mobile phone.
• Policy Change:  Just a few weeks ago, Pennsylvania became the 35th state to enact an anti-texting law.  The new law allows police to charge anyone caught text messaging while operating a vehicle with a primary offense and a $50 fine. 

As with most public health problems, we will need a combination of these strategies (i.e., individual education, social norm changes, policy/law changes, technological solutions, etc) to see a reduction in injuries and deaths.

What do you think?

• How can we balance the benefits and challenges of mobile technology for public health?
• Do you think the "E-Lane" in Philadelphia is an effective strategy for initiating dialogue around distracted drivers and pedestrians?
• In addition to the strategies listed above, what can public health and the public do to reduce injuries and deaths from distracted drivers and pedestrians?