Health and Social Hierarchy: Preschool Edition

(c) Nurse Blog

As every teacher knows (and hates), people start forming social hierarchies in preschool. But the dominant children aren’t just steamrolling the subordinate kids into giving up their toys, they may also be sentencing them to a life time of poor health.

University of British Columbia Neurologist and Child Development Special, Dr. Thomas Boyce, spoke about the “biology of misfortune” at the Harvard School of Public Health yesterday afternoon. Dr. Boyce began studying social hierarchies in children to try and explain why some children have medical charts with just a few pages, while others have charts as thick as phone books.

Socioeconomic status is frequently singled out as the biggest predictor of future health. It’s more influential than age, height, social support, and even smoking habits.  On top of that, health isn’t just related to objective social status, but also subjective social status— where people places themselves in the hierarchy. Suspecting that perceived social status started in childhood, Dr. Boyce decided to dig a little deeper.

Playing short video clips of children playing with one another, Dr. Boyce described the different kinds of hierarchy-establishing behaviour he found, including imitation, displacement, directing behavior, and good old-fashion physical attack.

In one clip, two small children are shown digging, with a third child, a little brown haired girl, first attempting to displace one child digging next to a tree before successfully displacing the second from his digging spot. After she tires of digging and moves on to something else, the child she originally tried to displace, a boy with a head full of blond curls, chases after her, grabbing her around the waist and trying to drag her back to the tree.

Dr. Boyce described this as “another demonstration of nuanced male behavior,” to laughs from the audience. The boy eventually figured out he could get the little girl to keep digging with him if he just asked her.

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HIV Preferable to Diabetes.

Did you know that doctors are learning how to re-grow body parts? It’s true. Not even just bladders and tracheas (as seen on Grey’s Anatomy), but finger tips and nails too. But are these kind of medical advances really what we should be spending our time on? I mean, we barely know how to feed ourselves.

This was the topic of debate this past Saturday at the Harvard Business School’s 8th Annual Healthcare Conference.

The conference kicked off with a keynote address from Robert Epstein, the Chief Medical Officer at Medco, who trumpeted regenerative medicine as one of the four “amazing innovations in science that hold the promise of true healthcare reform,” along with genetics, epigenetics, and stem cell therapies

But Epstein’s assertion that these breakthroughs will help bend the cost curve down was disputed in the very next panel. Larry Fitzgerald, the chief financial officer of the University of Virginia Medical Center, thinks those types of innovations will bring the cost curve up, because they extend life rather than eliminate disease.

“Instead of having neurological problems at age 80, we’re going to have them at age 95 or 100,” he said during the Health IT panel discussion. “We’re still going to have them.”

And so emerged the topic of the day: instead of sinking our resources into ground-breaking innovation, we should be concentrating on preventative medicine and behavioural changes?

According to the U.S. State Department, chronic diseases such as obesity and diabetes account for seven out of every ten deaths in the U.S. and are projected to cause the majority of deaths worldwide by 2020, outstripping infectious diseases such as malaria and HIV/AIDS.

This topic dominated the global health panel, since treating chronic diseases will be a new challenge to the healthcare non-profits, the majority of which currently address infectious diseases.

“We have patients in Sub-Saharan Africa who say they would rather HIV than diabetes, because they can get treatment for HIV,” said Epidemiologist and panelist Todd Reid.

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The Scientific Temper.

Does better science education create more rational human beings? Bruce Alberts thinks so.

For those of you not in the know, Bruce Alberts is the editor-in-chief of Science and a former president of the National Academy of Sciences. On Thursday Alberts spoke at Harvard University, his alma mater (where he both went to college and earned his Ph.D.), explaining why and how science education in America needs to change.

People stood in the back of the room and sat in the stairwells of the lecture hall, while Alberts explained how in 1996, while he was president, the Academy released a set of science education standards that sought to put the emphasis on abstract thinking and active inquiry.

The plan outlined experiments for even children as young as five. For example, the children could put on clean white socks and walk around in the school yard, collecting dirt and seed on their socks like animals do on their fur. Back in the classroom, they could then try and separate what they thought were seeds from what they thought was dirt, using inexpensive plastic microscopes. To test their hypotheses, the kids could plant both the seeds and the dirt to see which grew.

Unfortunately, what happened next Alberts refers to as a “disaster.” The states all chose different parts of the 1996 standards to adopt, and most of what was left out was the focus on abstract thinking and active learning. Instead, students’ science education focuses on memorization and word recognition.

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The Connectome is the New Genome.

TEDGlobal 2010 is still posting videos, less slowly, and they are still catering to me. In addition to stealing my catch-phrase about optimism, the most recent video they posted is about neurons, the study of which I am currently procrastinating.

In all fairness, this video is much cooler than my neurobiology homework. It features MIT professor Sebastian Seung is talking about a field of neuroscience that is still in its infancy—connectonomics. While I’m studying what individual neurons look like and how they communicate with one another, Seung is figuring out how these neurons are connected. How every neuron is connected.

His goal is to eventually map out the neuronal connections of an entire human brain—the connectome.

“You should just give up,” his friends tell him when he shows them how painstaking a process this is. But Seung hypothesizes that the connectome is the sum of memory and learning—things not encoded in the genome—making it different for everyone, even identical twins. With so much to gain, Seung presses on, acknowledging that a human connectome will likely not be mapped in his lifetime.

Sooo, he’s probably not getting a Nobel-prize. He’s worth listening to anyway.

TED Stalking.

As some of you may have noticed, I have a little thing for TED talks.

Maybe not just a little thing. Maybe more of a raging love affair. So when I found out that the Harvard Kennedy School and the Harvard School of Public Health were hosting a TEDxChange event, I was pretty excited, considering that this might be the closet I would ever come to actually attending a TED talk.

The live webcast, co-hosted with TED by Bill and Melinda Gates, took place on September 20, the 10th anniversary of the Millennium Development Goals. And other than Kennedy School students in front of me whispering about homework problems, it was pretty perfect.

The talk opened with Hans Rosling saying “come with me to the wonderful world of statistics,” to laughs from the audience. But in true TED style, Rosling makes statistics wonderful, narrating moving bubble graphs of child mortality like an announcer at the race track. He used the graphs to show that it’s unfair to talk about Africa as a whole when there are such huge discrepancies between Kenya, Ghana, Egypt, and the Democratic Republic of the Congo. He also added the shallow line of Sweden’s child mortality rate over the years to show that development is a long term investment.

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Influenza Pandemic Conspiracies.

As I reported earlier, finding a vaccine against the influenza virus is a bitch. But there is another way to fight future flu pandemics. Maybe.

Antiviral drugs, such as Tamiflu and Relenza, are purported to slow the spread of the influenza virus. Unlike vaccines, which need a copy of the current flu virus to make protective antibodies after injection, antiviral drugs work against multiple evolutions of the virus.

Rather than producing antibodies, antivirals work by disrupting the virus while it’s reproducing. Influenza reproduces by attaching to the surface of it’s human host’s cells, photocopying itself inside (with host photocopiers!), and then using an enzyme to destroy part of the host cell wall to release itself. Antivirals stop the flu’s enzyme from working, meaning the reproduced virus can’t escape from the host cell.

Now, that all does sound amazing, and the World Health Organization did recommend that governments stockpile these drugs, but just because I explained how the drug is supposed to work doesn’t mean it DOES work.

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Obesity. Still a Problem.

In case you were wondering, obesity is still a problem.

I know, I know. I am as surprised as you are. But honestly, you’d think that after all that media attention people would start changing their behaviour.

Nope. The New York Times reported earlier this week that obesity rates keep rising. Apparently more than 2.4 million people became obese from 2007 to 2009.

If you are concerned about how all of those newly obese and overweight people will be clothed, The New York Times Magazine reported last week that there are not enough fashionable plus-sized garments. Women above the standard clothing sizes have unpredictable body types, so few retailers have invested in the market, even though it’s growing.

It’s a particularly interesting story because it gives a history of the plus-sized woman through fashion. Though weight problems may seem a novelty of our generation, by 1923 Lane Bryant was already selling clothing for full-figured women and pulling in $5 million a year.

Anyway, in case you find this stuff depressing, design and innovation firm IDEO is trying to fix it. They just launched a new design platform called OpenIDEO, where people are encouraged to submit inspiration and possible solutions to proposed challenges.

How can this solve the obesity epidemic? Chef and healthy-eating advocate Jamie Oliver just challenged OpenIDEO users to think of new ways to encourage children to eat fresh food.

Can technology get us out of the sedentary life-style it helped create? We’ll have to participate and see.