At all levels of government there has been a serious push for increasing access to food among low income households and fostering more nutritious eating habits in communities and schools.
Last July, First Lady Michelle Obama and the Partnership for a Healthier America secured pledges from Wal-Mart, Walgreens, SuperValu and several other stores to open or expand stores in “food deserts”, bringing healthy affordable food to approximately 10 million people over the course of five years. Any specific information on how many will be served in CA?

That same month the First Lady also announced the California FreshWorks Fund, a public-private partnership loan fund with $264 million available to support grocery stores and other healthy food retailers in low-income, underserved communities in California. The California Endowment and a team of partners that include banks, grocers, health care providers, and nonprofits lead this initiative. Modeled after a successful program in Pennsylvania, this loan fund provides grants to healthy food retailers willing to locate stores in “food deserts”, areas lacking access to fresh, healthy food.

On Feb. 1, the First Lady spoke at a community event in Los Angeles to celebrate the progress that the California FreshWorks Fund has made in bringing affordable and healthy food to neighborhoods around the city. As one of its initial projects, the California FreshWorks Fund committed more than $20 million in funding to Southern California grocer Northgate Gonzalez Markets for its first three projects: a San Diego location as well as stores in Inglewood and South Los Angeles. The President and CEO of the California Endowment, Robert K. Ross, MD, also spoke at this event and enthusiastically stated, “we all have a shared interest in ensuring our neighborhoods, grocery stores and school cafeterias contribute positively to the health of our communities. Today’s announcement marks the beginning of what we hope will be a robust effort to expand access to nutritious food for all Californians!”

These commitments are a step in the right direction in the effort to combat the country’s obesity and hunger epidemics. Approximately one in four children in the U.S. live in a household that experiences hunger. Additionally, 30 percent of children in the U.S. are overweight or obese and among African Americans and Latinos the number soars to an estimated 40 percent.

Although hunger and obesity are oftentimes viewed as two distinct problems, they are deeply interconnected. Hunger and food insecurity are key contributors to obesity as low-income Americans are forced to rely upon high calorie, low nutrition foods to quell hunger pangs. Notably, studies have consistently demonstrated the lack of supermarkets and other stores selling healthy, affordable food in low-income communities as compared to wealthier ones. Adults in California neighborhoods with low access to healthy food are 20 percent more likely to be obese than those in higher-access neighborhoods, increasing their risk of developing chronic diseases. The California Fresh Works Fund website features a very useful interactive map that displays “Grocery Gap” statistics for various counties throughout the US and can be broken down into detailed indicators. The California FreshWorks Fund was created to tackle these food access concerns, while also addressing additional challenges faced by communities in so-called “food deserts”. In addition to improving community health, drawing grocery stores into “food deserts” also creates opportunities for economic development. Grocery stores create jobs (an estimated 49 to 120 new jobs per store), attract other small businesses to the area, and increase the surrounding residential real estate values.

Additional benefits include increased property values in the surrounding communities and increased income and property tax. This increased economic activity and property value help relieve pressure on state and local budgets and increase community sustainability.

California’s Freshworks Fund serves as a model for an innovative public-private partnership loan fund with the potential to increase access to healthy and affordable food throughout the state. This new program is proving itself as a vital component in California’s fight against hunger and obesity, and as an important force in strengthening the economies of affected communities.

Katie Wilczak, CAP CA Intern, contributed to this piece.

The letter acknowledged that the global economic and political climate puts foreign aid expenditures under pressure, but warned that a cut in these funds could have severe implications for populations struggling to pull themselves out of poverty:

The world faces a clear choice. If we invest relatively modest amounts, many more poor farmers will be able to feed their families. If we don’t, one in seven people will continue living needlessly on the edge of starvation. My annual letter this year is an argument for making the choice to keep on helping extremely poor people build self-sufficiency.

Gates argues that investment in poor farmers can “increase their productivity so they can feed themselves and their families,” and “contribute to global food security.” The past fifty years has marked dramatic improvements in poverty reduction — global poverty levels have dropped from 40 percent to 15 percent — but Gates is concerned that the historic improvements could slow if funding for irrigation and agricultural research dry up:

We can be more innovative about delivering solutions that already exist to the farmers who need them. Knowledge about managing soil and tools like drip irrigation can help poor farmers grow more food today. We can also discover new approaches and create new tools to fundamentally transform farmers’ lives. But we won’t advance if we don’t continue to fund agricultural innovation, and I am very worried about where those funds will come from in the current economic and political climate.

The Gates Foundation — which has committed more than $25 billion [PDF] in grants since its inception in 1994 — has been an outspoken supporter of government funding of global public health and poverty reduction programs. Gates’s letter emphasized that development assistance programs “has a significant impact on people’s lives” and “modest investments in the poorest make a huge difference.”

Earlier this week, CAP Senior Fellow and oncologist Zeke Emanuel co-authored an editorial that questions the increasing use of proton beam therapy to treat cancer patients, given the clear lack of clinical evidence on its efficacy and substantially higher costs.

In theory, proton beam therapy can zap cancerous tissue with much greater precision than conventional photon radiation treatment, minimizing damage to healthy tissue surrounding a malignancy and reducing side effects. Although proton beam therapy has been in use since the 1950s, randomized clinical trials for the treatment of prostate cancer -– which proton therapy is frequently used to treat — are completely lacking. Existing studies are smaller, single institution, and short-term, and are unable to evaluate long-term outcomes, including onset of delayed side-effects. Additionally, although proton beam therapy has been shown to effectively treat certain rare childhood cancers — mainly brain and spinal cord tumors — the treatment’s precision may actually miss potentially treatable disease that could be addressed through less-precise x-rays.

As major medical centers — including the University of Pennsylvania, M.D. Anderson, and the Mayo Clinic, among others –- invest hundreds of millions of dollars in building the football-field-size buildings needed to house the proton accelerators and in light of rapidly rising health care expenditures, we’re forced to ask, “It Costs More, but Is It Worth More?”

It seems that Mayo Clinic President and C.E.O. John Noseworthy might have an answer in several years, after spending more than $360 million building two new Mayo proton beam facilities, inevitably passing at least some of these costs on to cancer patients. Noseworthy states that Mayo, along with other proton centers in the U.S., will enroll patients in clinical trials once their proton facilities are up and running. But even if the results of the planned phase III clinical trials show that the protons are no more effective than photons, Mayo and others would still continue to use the machines, given their substantial up-front investment in the technology.

In his editorial, Noseworthy also claims that “hundreds of manuscripts” were reviewed over a six-year period to research the effectiveness of the treatment. Yet, he does not cite a single study, and doesn’t refute the lack of randomized clinical trials, the gold standard of clinical effectiveness assessments. If proton beam therapy does, in fact, produce more effective treatment outcomes, improve quality of life for cancer patients through reduced side effects and minimal damage to surrounding tissue, it may be a worthy investment for a wider population of cancer patients. But until then — show us the data!

The bad news for 2011:

– 2.2 percent increase in obesity.
– 4.8 percent increase in diabetes.
– 3.9 percent increase in child poverty.

The good news for 2011:

– 3.4 percent decline in smoking.
– 3.4 percent decline in preventable hospitalizations.
– 2.8 percent decline in cardiovascular deaths.

Vermont is still the healthiest state, with New York and New Jersey showing the most improvement, particularly in smoking cessation. “Idaho and Alaska showed the most downward movement. Idaho dropped 10 spots, from number nine to 19,” the report finds:

Now, a new study reveals that soda companies have been targeting black and Latino children in high numbers, diminishing parents’ attempts to encourage their kids to eat right:

A new report from Yale’s Rudd Center for Food Policy and Obesity has found that beverage companies are aggressively targeting black and Latino kids with ads to promote sports, fruit and energy drinks. The products that are promoted to kids of color happen to be among the least healthy of the 644 products studied by researchers at the university.

Black children and teens saw 80 percent to 90 percent more ads compared with white youth, including more than twice as many for Sprite, 5-hour Energy, and Vitamin Water.

From 2008 to 2010, Latino children saw 49 percent more ads for sugary drinks and energy drinks on Spanish-language TV. Latino preschoolers saw more Spanish-language ads for Coca-Cola Classic, Kool-Aid, 7 Up, and Sunny D than older Latino children and teens did.

Colorlines notes that the two largest soda companies, Pepsi and Coca-Cola, have repeatedly promised to market less to children, who are more susceptible to advertising: “Coca-Cola, for example, has previously stated publicly that they wouldn’t market ads in TV, radio and print programming aimed at kids under the age of 12.”

But the report found that soda companies have just shifted to using more sophisticated and insidious forms of advertising that promise kids rewards for purchasing sugary drinks. Kids are exposed to these messages “often without their parents’ awareness.”

Companies’ targeting of minority children is a social justice issue as well as an economic one. Just like mortgage companies that focused their predatory lending on minority communities, soda companies are preying on a particularly vulnerable group (poor children) who are already suffering the ill effects of their product and have the most to lose from consuming more. For instance, these children are less likely to have health insurance to cover the numerous medical problems associated with obesity.

by Nancy Bazilchuk, cross-posted from the Daily Climate

It started with Vic Rail’s horses, in September 1994. First one, then another, they died horrible deaths, 13 horses in all over the span of just two weeks, frothing from their noses and mouths, thrashing in agonizing pain. Then Rail died too.

Weeks later Australian officials isolated a newly discovered virus they ultimately named Hendra, after the Brisbane suburb where Rail and his horses died. For 17 years, Hendra virus smoldered in its host population of fruit bats killing nearly 50 horses and claiming three more human lives.

Then in May, something happened.

It was as if Hendra virus awoke from a slumber and roared fully into life. There have been more outbreaks of Hendra in 2011 – 18 at last count – than in the 16 previous years.

Veterinary epidemiologists hunting the virus now know definitively that Australia’s fruit bats (Pteropus sp.), also called flying foxes, spread the disease to horses, which then can infect humans. And while they don’t know the exact cause of the huge escalation in outbreaks, they strongly suspect it has something to do with the heavy rainfall and big floods that drowned northeastern Australia from November 2010 to February 2011.

And that has them looking nervously at climate change.

“The interesting change was the big floods in January,” said Raina Plowright, a disease ecologist at the Pennsylvania State University’s Center for Infectious Disease Dynamics. “Floods are expected more frequently with climate change – so, if they are linked, climate change may increase disease.”

Long list

Hendra virus is just one of a number of newly emerged zoonotic diseases, so called because they have their origins in animals but somehow make the leap to humans, and in doing so, wreak enormous havoc. While zoonotic diseases may sound exotic, one of the most devastating is also one of the most familiar: AIDS, which made the jump from primates to humans sometime at the beginning of the 20th century, and now kills an estimated 2.7 million people a year. Hendra, far newer but fearsomely lethal, has claimed the lives of four of the seven people infected.

The alphabet soup of deadly and economically damaging zoonotic diseases is long and includes West Nile virus, avian influenza and SARS, or Severe Acute Respiratory Syndrome – another disease thought to have jumped from bats to humans.

World health officials concluded in 2004 that more than three-quarters of new, emerging or re-emerging human diseases today are caused by pathogens originating from animals or animal products. Overall, between 1940 and 2004, scientists estimate there have been more than 300 emerging disease events around the globe – a number that will likely grow as population grows.

Increased food production and animal husbandry of waterfowl and pigs, which can harbor viruses like influenza, help explain the increasing emergence of these new, often virulent diseases, said Jan Slingenbergh, senior animal health officer and head of the emergency prevention system for the Food and Agriculture Organization, or FAO, a United Nations program working for food security.

Climate as complicating factor

Climate change adds yet another complicating factor, Slingenbergh said. It can expand the range of insects and arthropods that can transmit disease. Or, as may be the case with Hendra, it can cause ecological upheaval, adding to the likelihood that people will come into contact with virus-carrying animals. Animals on the wing – birds and bats – are like sick people on airplanes, he added: they can travel long distances with their viral burden.

“Whether it is about Hendra, Nipah or Ebola or some other bat-circulating virus or non-human primate virus, we know that sooner or later they are going to show up as novel infectious diseases in humans,” Slingenbergh said.

It’s not possible to make a blanket statement about how climate change will affect outbreaks of zoonotic diseases, scientists say. The interplay between temperatures, rainfall and shifting habitats is too multifaceted to boil down into one overarching trend. Closer contact of wild and domestic animals as well as advanced detection technologies further complicate the picture.

Spread of disease

But Linfa Wang, a scientist working on the Hendra outbreak for Australia’s Commonwealth Scientific & Industrial Research Organization, or CSIRO, said climate change clearly amplifies other factors contributing to the increase in zoonotic outbreaks. “None of these virus outbreaks would have been identified 50 years ago,” he said.

The world community has responded to this ever-increasing onslaught of diseases by looking harder for them before they become full-blown pandemics.

The U.S. Centers for Disease Control and Prevention runs the National Center for Zoonotic, Vector-Borne, and Enteric Diseases; part of its mandate is to evaluate how climate change will affect the prevalence and spread of zoonotic diseases, such as Hanta virus in the American Southwest.

CDC efforts aside, though, many see zoonotic diseases as confined to steamy jungles or crowded third-world marketplaces teeming with live chickens and pigs. Hendra’s emergence, Plowright said, shows we need to forget that stereotype.

Think of it this way: Ebola, West Nile, Nipah, and now Hendra. If this list of virulent, deadly infectious agents were an SAT question that asked you to identify the one different from the others, what would be the answer? All four are named for locales where the “patient zero” case was isolated. All four are recently emerged zoonotic viruses.

But get out your atlas and look: Ebola is in the Democratic Republic of the Congo, West Nile is in East Africa, Nipah is in Malaysia – all but Hendra are named for places in underdeveloped countries. Hendra virus “is going on in a country just like America,” Plowright said. “This is just like the prequel to Contagion.”

Environmental stress

Veterinarians believe one of the key causes of the Hendra virus outbreaks is environmental stress. Fruit bats naturally harbor the virus, but it doesn’t make them physically ill. Instead, Plowright and others have found that when the bats are stressed, the percentage infected with Hendra rises dramatically, possibly making it easier for them to spread the disease to horses.

Explaining what stresses bats isn’t straightforward, however. Normal environmental stress, such as giving birth or winter scarcity of food, stresses them. Environmental change – the big floods in January, which destroyed food sources – also stresses them.

There are also paradoxical stresses, such as habitat encroachment, which send bats off on a hunt for new food sources. This brings them closer to people, because humans tend to plant fruit trees. Biologists have found that bats in some urban and suburban areas of Australia are abandoning their migratory behavior and becoming sedentary because neighborhood fruit trees are available. This sedentary behavior on the part of some animals has led populations to fragment, which may be another important reason behind the outbreaks.

Big populations of migratory bats mingle with one another, which epidemiologists believe allows the bats to share a low level of Hendra infection – conferring on the population as a whole something called herd immunity. But when normally migrating bats become sedentary, Hendra virus immunity may wane. “Our models predict that Hendra virus used to be like a slow burning fire with very little kindling, because it was everywhere,” Plowright said. But now, it has “changed to a few big fires.”

Troubling route

The call that really put veterinarians and public health officials on high alert came in July, when Dusty the dog, who had been living on a property in Mount Alford where three horses were infected with Hendra, also was found to have the disease. While the dog did not seem to be contagious, the finding opened another, more troubling route for human infections.

The virus also can lie dormant – Mark Preston, who helped perform an autopsy on a dead horse, died from the virus a year after he did the autopsy. And while Hendra is not now contagious in humans, when humans contract the disease, it has a lethality of close to 60 percent. Ebola, for comparison, has a fatality rate of 68 percent.

The outbreaks have also become part of the political landscape: There have been calls to remove Queensland Premier Anna Bligh and Agriculture Minister Tim Mulherin.

One thing is certain, health experts say: As the planet grows hotter and more crowded, the range and severity of zoonotic outbreaks will increase.  Hendra, so far, has exacted a minor human toll. H5N1 avian flu, in contrast, required the culling of hundreds of millions of chickens, and cost Asia’s farmers $10 billion.

World health officials, reading this trend, are trying to get ahead of it. They’ve issued a call to arms – “One Health,” a global endeavor led by the FAO, the World Bank, the World Health Organization, the World Organisation for Animal Health and the United Nations Development Programme. More than 600 scientists and public health doctors are involved, pursuing the idea that the health of humans, animals and the environment are inextricably linked.

The current tack – where doctors treat people, veterinarians handle animals, and biologists focus on plants – doesn’t work, said the FAO’s Slingenbergh. “The microbes … do not recognize our compartmentalized approach.”

“An interdisciplinary approach is the only possible answer to stop this continuous generation of novel diseases.”

Nancy Bazilchuk is a freelance reporter based in Trondheim, Norway. Her work has appeared in Audubon, ScientificAmerican.com, and Conservation. DailyClimate.org is a foundation-funded news service that covers climate change.

by Frances Beinecke, cross posted from NRDC’s Switchboard

When I speak to lawmakers and business leaders about the costs of climate change, they tend to think in terms of damaged property and lost agricultural revenue. Certainly the fires in Texas and the flooding from Vermont to Virginia have brought home the staggering costs associated with rebuilding homes and replanting crops. But one cost of extreme weather has gone nearly unreported: health care.

In a groundbreaking study published recently in Health Affairs, a group of NRDC scientists and university economists looked at six climate-change-related events that happened in the United States in the last decade.

These extreme events accounted for more than $14 billion in health-related care costs and more than 760,000 interactions with the health care system.

As climate change intensifies, these medical bills will rise dramatically.

Today a report by the world’s leading body of climate scientists concluded that global warming is causing more extreme weather events and they will become even more frequent in the decades ahead.

That means greater health threats and higher medical costs.

We are already seeing the toll these events take. Extreme weather routinely sends people to emergency rooms with injuries, respiratory illness, and other life-threatening conditions.

In a blistering heat wave that hit California in 2006, 655 people’s deaths, 1,620 hospitalizations, and more than 16,000 excess emergency room visits resulted in nearly $5.4 billion dollars in costs, according to the new study.

When the Red River flooded in North Dakota in 2009, the news media covered the damage done to homes and communities. But few realized that the two deaths, 263 emergency room visits, and an estimated 3,000 outpatient visits associated with the flood generated more than $20 million in health-related costs.

And across the United States in 2002, high temperatures increased the amount of smog pollution in the air, exposing nearly 288 million Americans to smog levels higher than those deemed safe for public health.  This extra pollution hastened the death of 795 people, caused 4,150 hospitalizations, and prompted more than 365,000 outpatient visits. This smog-related medical care came at cost of $6.5 billion.

If we want to shield our families from these health hazards and stop the escalation in medical costs, America must set limits on global warming pollution.

President Obama has made an impressive start. The clean car standards he announced in July will cut carbon emissions from vehicles in half and save Americans $80 billion a year at the pump. But cars and trucks are only one piece in the puzzle.

Power plants account for 40 percent of U.S. carbon emissions, yet there is no limit on how much global warming pollution these plants can release. The Obama administration is expected to set limits on carbon pollution on plants. Together with the clean car standards, these new safeguards would cover two-thirds of the nation’s global warming pollution.

This is the kind of progress we must make if we want to save money and lives in the decades ahead.

Frances Beinecke is the president of the Natural Resources Defense Council. This post was originally published at NRDC’s Switchboard blog.

Just weeks after voters in Denver failed to pass a local paid sick days initiative, a new study to be published in the American Journal of Public Health demonstrates how a lack of workplace policies such as paid sick leave contributes significantly to illness among Hispanics — and thus the general population.

Potential exposure to H1N1 during the 2009 pandemic was significantly related to race and ethnicity, with Hispanics having the greatest risk of infection. Even after controlling for income and education, Hispanics had the highest probability of contracting an influenza-like illness, due to the absence of paid sick leave and structural factors such as the number of children living in the household.

The lack of paid sick leave among Hispanic workers contributed to an estimated 1.2 million cases of influenza-like illness among Hispanics, and 5 million additional cases in the general population.

Nearly 60 percent of Latino workers — about 12 million people — do not have access to paid sick days through their employers. Latino adults are more likely to be in the workforce than any other racial or ethnic group, and they are also more likely to work in service industry jobs such as personal care or food service — jobs where they are in direct contact with the public and where paid sick leave is less commonly offered.

Thus, the person preparing your food at a restaurant is disproportionately likely to be Latino, and is also disproportionately unlikely to have paid leave that would allow him to stay home if he caught the flu. Other research has shown that a lack of paid sick days resulted in employees of all races and ethnicities who were infected with H1N1 going to work while sick, thus infecting an estimated additional 7 million individuals — as many as 1,500 of whom died as a result.

Opponents of the ballot initiative in Denver (which included the National Restaurant Association and Keep Denver Competitive, funded by chains like KFC and Pizza Hut) spent hundreds of thousands of dollars arguing that paid sick days are too expensive in this economy. But the real question — when millions of people are infected with avoidable illnesses, and over a billion dollars is being spent each year on preventable ER visits — is too expensive for whom?

This is the true joy in life, the being used for a purpose recognized by yourself as a mighty one; the being a force of nature instead of a feverish, selfish little clod of ailments and grievances complaining that the world will not devote itself to making you happy.

I am of the opinion that my life belongs to the whole community, and as long as I live it is my privilege to do for it whatever I can.

I want to be thoroughly used up when I die, for the harder I work the more I live. I rejoice in life for its own sake.

Life is no “brief candle” for me. It is a sort of splendid torch which I have got hold of for the moment, and I want to make it burn as brightly as possible before handing it on to future generations.”

– G. B. Shaw, quoted by Dr. Eric Chivian in his remembrance of Paul

I was fortunate to get to know him over the years in the various meeting we attended together and then through blog posts he submitted.  He was passionate and brilliant and tireless and thoughtful, a physician and public health expert who helped steer scientists and climate hawks toward a crucial understanding of the impact on humans of human-caused global warming.  He was a great communicator who schooled us all on how to convey scientific information to the general public.

You can read some of his prolific work on the subject of health impacts of climate change here, including his  New England Journal of Medicine article, “Climate change and human health” and the exhaustive Climate Change Futures: Health, Ecological and Economic Dimensions.  You can read the NYT obituary here.

Here is a post on his groundbreaking article detailing the economic, health and environmental costs associated with each stage in the life cycle of coal – extraction, transportation, processing, and combustion: Life-cycle study: Accounting for total harm from coal would add “close to 17.8¢/kWh of electricity generated.” But he had diverse interests, as evidenced by his September 17 Climate Progress post explaining how a a levy on currency transactions could fund the clean energy transformation and healthy development.

Epstein was associate director of the Center for Health and the Global Environment at Harvard Medical School.  The director, Dr. Eric Chivian, a longtime friend and colleague of Epstein’s, sent out a long remembrance of him, which he has given me permission to repost in full.

He ends by saying, “When thinking about Paul’s life, and my own, and that of others I love, I think of what George Bernard Shaw said in 1907, as it says it all about Paul.”  After relaying the quote above Chivian says:

Let us grab the torch from Paul and make sure that it burns as brightly for us and for the world as it did for him.

Here are some details of the remarkable life of Dr. Paul Epstein from Dr. Chivian:

I have known Paul for over 30 years and have worked intensively with him for over 20. It is not really possible to summarize his life and his work, but I will try as best I can by mentioning what stands out for me.

*  Rio de Janeiro, June, 1992-Paul and I are at the Earth Summit (UNCED), holding a well-attended press conference “Where is Human Health at Rio?” after both of us are asked repeatedly “what are physicians like yourselves doing at an environmental conference,” and after being startled that there is almost no mention of health in the proceedings. Paul releases a report linking the cholera epidemic, then going on in Peru, to algal blooms caused by warming sea surface temperatures and nutrient discharge. The report is covered by the Wall Street Journal. It became clear to me then that Paul was a master at reading Nature’s signals of our damage to the environment, and at understanding the implications of this damage to our lives. He was also a “black belt” in knowing how to get this information out to the public.

[a footnote here-Both Paul and I, along with many other physicians, were profoundly influenced by Alex Leaf's seminal 1989 article in the New England Journal of Medicine {Vol. 321(23):1577-1583} "Potential Health Effects of Global Climatic and Environmental Changes" where Alex, a mentor to many of us, called on physicians to educate others, as we had with nuclear war, about the human health dimensions of global environmental changes.]

*  Spring, 1996-I propose to Paul, Mary Wilson, Howard Hu, and Dan Goodenough that they join me in starting the Center for Health and the Global Environment at Harvard Medical School. Dan gives us space in the Holmes Society; HMS Dean Dan Tosteson is an enthusiastic supporter, as is the Academic Council; and we officially become a Center, the first center at a medical school in the country focused on health and global environmental change. Jim McCarthy, Edward Wilson, and several other faculty from around the university join us from the start in this effort.

*  Fall, 1997-Paul, Dan, Howard, and I (later to be joined by Tim Ford and Melissa Perry) begin teaching “Human Health and Global Environmental Change” at HMS. Open to all students at Harvard, the course becomes one of the most popular and highly rated environmental courses at the university for a decade. More than 500 students take it for credit. The course is held, in whole or in part, by 65 other medical schools, colleges, and grad schools around the world. [Note-the course has been re-started last year at the Harvard School of Public Health and is now run by Ari Bernstein]

*  December, 1997-Paul and I go to the Kyoto Summit together, having just released a full page, Center-initiated letter to Presidents Clinton and Yeltsin and other world leaders, in the NY Times on Dec. lst, 1997 “Medical Warning: Global Warming” signed by several hundred leading physicians from 30 countries.

*  Fall, 1998-Paul and I start an intensive Center course for congressional staff “Environmental Change: the Science and Human Health Implications” which we hold each year for 10 years, establishing close working relationships with key staffers, Republicans and Democrats, from the House and Senate.

*  Paul and I together hold a total of 23 Center congressional briefings, each one sponsored by both Republicans and Democrats, such as Paul’s briefing “Oceans, Climate and Human Health”

*  Paul and I publish, separately and together, more letters to the editor and op/eds over the past decade in the NY Times, Boston Globe, and other newspapers than perhaps any two people from any organization in the country.

*  Paul was a central figure in our historic Scientist-Evangelical Initiative and led presentations, with his evangelical colleagues, at several Christian colleges, making many close friends and catalyzing the formation of “green groups” at these colleges.

*  Paul released a series of widely distributed, highly influential reports, including, among several others:

1.   Marine Ecosystems: Emerging Diseases as Indicators of Change
2.   Oil: A Life Cycle Analysis of its Health and Environmental Impacts
3.   Climate Change Futures: Health, Ecological and Economic Dimensions
4.   Healthy Solutions for the Low Carbon Economy: Guidelines for Investors, Insurers and Policy Makers
5.   Full Cost Accounting for the Life Cycle of Coal

*  Paul publishes very widely in the peer-reviewed medical and scientific literature: the Lancet, New England Journal of Medicine, Science, Scientific American, Bulletin of the American Meteorological Society, and the Annals of the NY Academy of Sciences, among many others.

*  Paul appears on radio and TV programs too numerous to count-from the networks and major cable to small local stations-he always had time to speak to any reporter, to patiently explain what concerned him most.

Paul’s curiosity was insatiable. He read incessantly, widely and deeply-newspapers, journals, reports, books-in many and varied fields, and seemed equally at home discussing such topics as: the dynamics of El Ninos, heat transfer and the ocean’s conveyor belt, and the life cycle of bark beetles, as he was with subjects like the necessity of instituting a Tobin tax on global financial transactions.

He was one of the first people to link extreme weather events with the emergence and spread of human infectious diseases. He was one of the first people to recognize the independent effects of greenhouse gases on the environment and human health, independent of their impact on temperature and precipitation, by looking, for example, at ragweed pollen output. He was one of the first people to involve the financial, insurance, and
reinsurance sectors in addressing climate change, and in helping them understand why they had to be involved.

I could go on and on and on about his critically important contributions to our better understanding what we face by damaging the natural world.

But what was most important to me about Paul, perhaps even greater than all that I have written above, is that he was a true gentleman, a gentle man, a mensch. He saw the best in people, was always available to students and reporters, to public groups who wanted him to speak, really to anyone, great and small, who asked what he was thinking about.

He taught us all the value of learning everything you could about our impact on the environment and of helping others understand what you have learned–clearly, in everyday language, patiently, respectfully, without condescension. He taught us all that one should never give up in these efforts.

Even when he was quite ill and realized his time was short, Paul spoke to large numbers of reporters and published many articles and blogs with a frenzy of intensity. It was during this time that he finished his remarkable book with Dan Ferber Changing Planet, Changing Health.

And Paul taught us all how to face one’s own death with quiet dignity and great courage.

– Zachary Britt

Access to health care goes beyond health insurance and health care services. It also includes workers’ ability to take paid sick time to recover from a common illness, care for a sick loved one or seek preventive care.

In Congress and across the country, advocates and legislators are pressing for paid sick days policies that would guarantee working people the right to take time away from work when they, their spouse or partner, and their children are sick. For LGBT families, legislation that provides paid sick time to care for themselves and their loved ones is critical.

Here are some basic facts: 44 million workers in the United States can’t take a single paid sick day when they are ill. Millions more lack paid sick time to care for an ill child or family member. Workers without paid sick days face an impossible choice when illness strikes – ignore their health needs and the health of their family, or lose a much-needed paycheck and risk losing their jobs.

For LGBT workers and their families, the choice can be even more daunting. LGBT families live throughout the United States, and more than 1 million same-sex couples across the country are raising children. However, LGBT people are regularly discriminated against in employment, relationship recognition, and insurance coverage, and the vast majority of LGBT workers have few protections against workplace discrimination. In most states, workers can be fired just because of their sexual orientation or gender identity. This vulnerability makes it all the more challenging to take a sick day that could generate negative attention or result in job loss. For transgender workers, many of whom may have specific medical needs that require time off from work, the pressure can be even worse.

For LGBT parents who may not have legal rights with respect to their partners’ children and whose employers may not recognize these relationships, it can be even harder to have access to the benefits and flexibility needed to keep their commitment to protecting the health of their families.

As a result, rather than take a risk by seeking time away from work for their health or the health of a child, LGBT workers may feel compelled to send a sick child to school or day care, delay care, or skip necessary recovery and treatment altogether. The negative health consequences of going that route are obvious.

Nationally, workers without paid sick days are 1.5 times more likely than those that have them to go to work sick with the flu and other contagious diseases, spreading germs to co-workers and customers. Those without paid sick days are also more likely to live in households where family members delay or forgo preventive care.

A paid sick days standard that applies to all workers, regardless of sex, sexual orientation, gender identity or relationship status, would guarantee workers time to recover from illness and care for a sick loved one, improving their overall health and the health of their communities. Working parents could get their children the care they need and be able to take time away from work if a health emergency strikes.

Fortunately, there is federal legislation that would establish a paid sick days standard and promote worker health. The Healthy Families Act has been introduced in the last two Congresses and is expected to be reintroduced soon. The legislation would give workers the ability to earn a few job-protected paid sick days each year to use to recover from their own illness or seek medical care – or to help a child or partner who is sick or needs to see a doctor. Under the bill and most proposed state laws, workers could use their paid sick days to care for immediate family members, including same-sex spouses, domestic partners and children.

One state (Connecticut) and three cities – San Francisco, Washington, D.C. and Seattle – have already taken the lead and enacted paid sick days laws that apply explicitly to LGBT families. And in nearly 20 states and cities, a national movement for paid sick days is gaining ground. Learn more and join the movement at www.PaidSickDays.org.

HHS Secretary Kathleen Sebelius celebrated the progress in LGBT health with her opening remarks before the National Coalition for LGBT Health at their annual meeting yesterday. The National Coalition for LGBT Health was formed 10 years ago when health advocates came together to improve the health and well-being of the LGBT population. Sebelius highlighted some of the progress in LGBT health equality over the past decade:

- Greater inclusion of the LGBT population into the goals of Healthy People 2020

- A ruling that any hospital accepting Medicare or Medicaid must provide all patients, including those with same-sex partners, the right to choose who can visit them in the hospital

- A HHS non-discrimination policy that prohibits HHS employees from discriminating against anyone eligible for the department’s programs on the basis of sexual orientation or gender identity

- The release of HHS recommendations for providing the best possible care in shelters for homeless LGBT youth

- The development of the LGBT Data Progression Plan that integrates questions regarding sexual orientation and gender identity into HHS national surveys, facilitating greater data collection on the LGBT community

The LGBT Data Progression Plan has been a particularly great stride forward, since improved data collection is critical to understanding and addressing health care disparities. The plan will help HHS determine if the LGBT community should be designated a “health disparity population,” which would provide important resources for tackling inequality and establish LGBT health as a specific subsection of Healthy People 2020. Better data of the LGBT population will also ensure that LGBT interests are equally addressed in the implementation of the Affordable Care Act.