Public Health, Environmental Health, and Activism

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Public Health, Environmental Health, and Activism

• Martin Donohoe

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Am I Stoned?

• A 1999 Utah anti-drug pamphlet warns
• Danger signs that your child may be smoking
  marijuana include excessive preoccupation with
  social causes, race relations, and environmental
  issues

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Schism between medical schools and schools of
public health

• Dates back to the early twentieth century
• Medical schools more focused on biochemical
  mechanisms of disease and drug therapies
• Public health focused on populations and societal
  issues
• Few contemporary physicians have public health
  training

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Important Contributions of Public Health

• Water and food safety
• Sanitation
• Vaccination
• Fluoridation
• Iodine supplementation of table salt
• Seat belts, air bags
• Bed nets for malaria prevention
• Barriers to decrease bridge suicides

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Reasons for Underfunding of Public Health (NEJM
362181657-8)

• Benefits of public health programs lie in the
  future
• Beneficiaries of public health measures are
  generally unknown
• Benefactors are often unknown
• Opposition to public health programs often
  political, corporate
• Medical care usually promoted by corporate
  interests

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Medical Ethics Today

• Overemphasizes individual conflicts and
  fascinating dilemmas involving expensive
  technologies (e.g., gene therapy, cloning, face
  transplants)
• Underemphasizes the psychological, cultural,
  socioeconomic, occupational, and environmental
  contributors to health

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The State of U.S. Health Care

• 51 million uninsured patients
• Millions more underinsured
• Remain in dead-end jobs
• Go without needed prescriptions due to
  skyrocketing drug prices
• Est. 51,000 deaths/year due to lack of health
  insurance

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The State of U.S. Health Care

• US ranks near the bottom among westernized
  nations in life expectancy and infant mortality
• 20-25 of US children live in poverty
• Gap between rich and poor widening
• Racial inequalities in processes and outcomes of
  care persist

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Headline from The Onion

• Uninsured Man Hopes His Symptoms Diagnosed This
  Week On House

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Maldistribution of Wealth

• U.S Richest 1 of the population owns 50 of
  the countrys wealth poorest 90 own 30
• Widest gap of any industrialized nation

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Maldistribution of Wealth

• Less than 4 of the combined wealth of the 225
  richest individuals in the world would pay for
  ongoing access to basic education, health care,
  adequate food, safe water, and adequate
  sanitation for all humans (UNDP)

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Overconsumption (Affluenza)

• U.S. 6.3 of worlds population
• Owns 50 of the worlds wealth
• U.S. responsible for
• 25 of worlds energy consumption
• 33 of paper use
• 72 of hazardous waste production

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Income Inequality

• Lower life expectancy
• Higher rates of infant and child mortality
• Short height
• Poor self-reported health
• AIDS
• Depression
• Mental Illness
• Obesity

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Voltaire

• The comfort of the rich rests upon an abundance
  of the poor

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George Orwell

• Some people are more equal than others

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Hudson River, 2009
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Racial Disparities in Health CareAfrican-America
ns

• Higher maternal and infant mortality
• Higher death rates for most diseases
• Shorter life expectancies
• Less health insurance
• Undergo fewer diagnostic tests / therapeutic
  procedures

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Racial Disparities in Health CareAfrican-America
ns

• Equalizing the mortality rates of whites and
  African-Americans would have averted 686,202
  deaths between 1991 and 2000
• Whereas medical advances averted 176,633 deaths
• AJPH 2004942078-2081

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Primo Levi

• A country is considered the more civilized the
  more the wisdom and efficiency of its laws hinder
  a weak man from becoming too weak or a powerful
  one too powerful.

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Meanwhile, Outside the US

• 1 billion people lack access to clean drinking
  water
• 3 billion lack adequate sanitation services
• Hunger kills as many individuals in two days as
  died during the atomic bombing of Hiroshima

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James Nachtwey
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Competitive Strategies of Financially-Strapped
Academic Medical Centers

• Tuition hikes (?rising medical student debt)
• Close public and charity hospitals
• Single specialty hospitals

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Competitive Strategies of Financially-Strapped
Academic Medical Centers

• Recruit wealthy, non-U.S. citizens as patients
• More aggressive billing practices / charging the
  uninsured higher prices

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Competitive Strategies of Financially-Strapped
Academic Medical Centers

• Increase cash services (botox treatments,
  cosmetic surgery) and reimburseable, covered
  services (e.g., cardiac catheterization, bone
  density testing)
• Pay sports teams for privilege of being team
  doctors (in return for free publicity)
• Develop luxury primary care clinics

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The Medical Brain Drain

• Five times as many migrating doctors flow from
  developing to developed nations than in the
  opposite direction
• Example of inverse care law
• Those countries that need the most health care
  resources are getting the least

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Rudolph Virchow

• Doctors are natural attorneys for the poor If
  medicine is to really accomplish its great task,
  it must intervene in political and social life

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Jacob Riis
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Dorothea Lange
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Care for All Equally

• A society should be judged not by how it treats
  its outstanding citizens but by how it treats its
  criminals
• -Fyodor Dostoyevsky

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• PROBLEMS
• And
• SOLUTIONS

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Colonial Exploitation

• Christopher Columbus log entry upon meeting the
  Arawaks of the Bahamas
• Theybrought usmanythingsThey willingly
  traded everything they ownedThey do not bear
  armsThey would make fine servantsWith fifty men
  we could subjugate them all and make them do
  whatever we want.

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Colonial Exploitation

• Cecil Rhodes (Rhodesia, Rhodes Scholarship,
  DeBeers Mining Company)
• We must find new lands from which we can easily
  obtain raw materials and at the same time exploit
  the cheap slave labour that is available from the
  natives of the colonies. The colonies would also
  provide a dumping ground for the surplus goods
  produced in our factories.

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Sebastiao Salgado
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Exploitation leads to

• Maldistribution of wealth and resources
• Environmental degradation
• Wars
• Over 250 wars in 20th Century
• Most deaths among civilians
• Militarism and war divert financial and
  intellectual resources away from social needs
• Weapons of mass destruction

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Contemporary Research Imbalances and Exploitation

• Unethical research on special populations
  (cultural minorities, prisoners, developing
  world, etc.)
• Majority of phase 3 US drug company trial sites
  outside US, many in developing countries
• 90 of research dollars spent on diseases
  affecting 10 of the worlds population
• Limited access of developing world to results due
  to scarcity of open-access publications

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Womens Health

• Political, legal, and educational marginalization
• Violence
• Impaired access to reproductive health care
• Female genital cutting

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Status of Women

• Economic discrimination
• Women do 67 of the worlds work
• Receive 10 of global income
• Own 1 of all property
• A woman in a developing country walks an average
  of 6 km/day to obtain water
• Heavy exposure to indoor biomass cooking stoves

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Environmental Degradation Pollution

• Air pollution causes approximately 60,000 -
  75,000 premature deaths/yr. in U.S., 1.8 million
  worldwide
• NAS Pesticides in food could cause up to 1
  million cancers in the current generation of
  Americans

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Air Pollution
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Air Pollution
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Environmental DegradationToxic Exposures

• 13,000-15,000 deaths per day worldwide from
  water-related diseases
• In developing countries, 90-95 of sewage and 70
  of industrial wastes are dumped untreated into
  the local water supply
• 1 in 4 U.S. citizens lives within 4 miles of a
  Superfund site
• Lead and mercury exposure multi-billion dollar
  problems

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Water PollutionBathtubToiletSource of
Drinking Water
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ToxinsMinimata Disease - W Eugene Smith
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Environmental Degradation Deforestation
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Greenlands Ice Cap Melting 1992
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Greenlands Ice Cap Melting 2002
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Greenlands Ice Cap Melting 2005
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Climate Change Drought
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Agriculture

• Commodification of worlds food and water supply
  by corporations
• Spread of GMOs and Biopharming
• Factory farms
• 1 polluters of American waterways
• Agriculture accounts for 70 of U.S. antibiotic
  use
• 1 contributor to food-borne, antibiotic-resistant
  infections (CDC)

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Factory Farming
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OverfishingFactory Trawlers
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Dynamite Reef Fishing
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Environmental Degradation Species Loss

• Largest mass extinction since the demise of the
  dinosaurs 65 million yrs ago
• Lost Pharmacopoeia
• More than 1/2 of the top 150 prescription drugs
  contain an active compound derived from or
  patterned after natural products-e.g. digoxin,
  vincristine, paralytic agents, etc.
• Of the more than 250,000 known flowering species,
  lt0.5 have been surveyed for medicinal value

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A Cure for Cancer?
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War and Militarism

• Diversion of economic resources and intellectual
  capital
• Military worlds largest polluter
• Prejudice/hate crimes
• Erosion of civil liberties
• Weapons of mass destruction

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2009 Federal Budget2.65 trillion
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The Military Diversion of Resources Away from
Health Care

• 3 hours world arms spending annual WHO budget
• 3 weeks of world arms spending/yr. primary
  health care for all in poor countries, incl. safe
  water and full immunizations

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War and Peace

• World military budget 1,470 billion in 2008
• 190X what the UN spends on peacekeeping
• US
• Largest military budget, largest arms supplier
• Greatest debtor to UN peacekeeping fund

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• Every gun that is made, every warship launched,
  every rocket fired, signifies in the final sense
  a theft from those who hunger and are not fed,
  those who are cold and not clothed.
• Dwight D. Eisenhower

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Kuwaiti Oil Fires Gulf War I
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Impediments to Public Health and Social Justice

• Political climate
• Scientific Ignorance
• Pseudoscience
• Damaged educational system
• The corporate media
• All lead to the decline of democracy

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Bush Administration

• Key administrators/committee members/regulators
  former industry representatives and/or lobbyists
• Privatization of public services
• Corporate profit before public good
• Unsound/distorted/suppressed science

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Bush Administration

• Rollbacks of key environmental laws
• Lax enforcement of existing laws
• Huge tax cuts primarily benefit wealthy
• Federal and state government deficits
  astronomical
• Program and funding cuts
• Trade deficit increased

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Obama Administration

• Overturns global gag rule
• Some improvements in FDA, EPA
• Withdrawal (partial) from Iraq
• Failure to consider single payer health care
• Supports genetically-modified crops
• Appointees holdovers (philosophically and
  personally) from prior administrations
• ?The future?

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Would You Sign a Petition to Ban Dihydrogen
Monoxide?

• 1. It can cause excessive sweating and
  vomiting2. It is a major component in acid
  rain3. It can cause severe burns in its gaseous
  state4. It can kill you if accidentally
  inhaled5. It contributes to erosion6. It
  decreases effectiveness of automobile brakes7.
  It has been found in tumors of terminal cancer
  patients

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Environmental and Geographic Ignorance

• A majority of Americans believe that electricity
  in the U.S. is produced in nonpolluting ways
• 25 knew that majority (70) comes from oil,
  coal and wood
• Percent of US teens unable to locate the
  following on a map
• United States 11
• Pacific Ocean 29
• Japan 58

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Contributors to Poor Education

• U.S. public education system in disarray
• Mass media consolidation, corporate influence

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Television

• The average American youth spends 900 hrs/yr in
  school, 1,500 hrs/yr watching TV
• By age 65, the average American will have spent 9
  yrs watching TV
• Contributor to obesity epidemic

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Global Warming Controversial?

• Of 928 articles in peer-reviewed scientific
  journals, 0 were in doubt as to the existence or
  cause of global warming
• Of 636 articles in the popular press (NY Times,
  Washington Post, LA Times, WSJ), 53 expressed
  doubt as to the existence (and primary cause) of
  global warming
• Science 20043061686-7
• (Study covers 1993-2003)

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Global Warming

• Causes estimated 160,000 deaths and 5.5 million
  disability-adjusted life years lost per year
• WHO, UN Environment Program

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Corporations Dominate the Global Economy

• 53 of the worlds 100 largest economies are
  private corporations 47 are countries
• GM is larger than Denmark and Turkey
• Wal-Mart is larger than Israel and Greece

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Corporations

• 90 of transnational corporations headquartered
  in Northern Hemisphere
• 500 companies control 70 of world trade
• Corporations shouldered over 30 of the nations
  tax burden in 1950 vs. 8 today

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Corporations

• Purpose Make money for shareholders
• Internalize profits
• Externalize health and environmental costs

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The Stock Market

• The top 1 of Americans owns 51 of all stocks,
  bonds, and mutual fund assets
• Consequences of Differential Stock Ownership
• Corporations are answerable to their shareholders
• Governments are answerable (at least in theory)
  to their citizens (either through elections or
  revolutions)

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Corporations

• Confidential legal settlements keep important
  public health and safety information secret
• May delay governmental intervention, cause
  unnecessary morbidity and mortality
• Corporate crime costs nation 35-150 times as much
  money as street crime

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Corporate PR Tactics

• Advertising
• Greenwashing
• Sponsored educational materials
• Co-opting scientists and academic institutions

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Corporate PR Tactics

• Media control
• Lobbying
• Astroturfing - artificially-created grassroots
  coalitions
• Corporate front groups

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Corporate PR tactics

• Invoke poor people as beneficiaries
• Characterize opposition as technophobic,
  anti-science, and against progress
• Portray their products as environmentally
  beneficial despite evidence to the contrary

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Lobbying

• Almost 15,000 full-time lobbyists
• Estimates of return on lobbying range from 28 to
  100 for every 1 spent

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Lobbying

• Pharmaceutical lobby spent 1.3 billion on
  lobbying between 1998 and 2007 (more than any
  other industry)
• 110 million in first half of 2010
• 1,228 lobbyists (2.3 for every member of Congress)

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Lobbying

• Lobbying groups spent 3.5 billion in 2009
  (federal lobbying, a record)
• All single issue ideological groups combined
  (e.g., pro-choice, anti-abortion, feminist and
  consumer organizations, senior citizens, etc.)
  spent well-under 100 million

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Corporate-Sponsored Environmental Education
Materials

• Exxons Energy Cube
• -Gasoline is simply solar power hidden in
  decayed matter
• -Offshore drilling creates reefs for fish
• American Nuclear Societys Activities with the
  Atoms Family
• Dows Chemipalooza

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Advertising

• US now spends 290 billion/yr on advertising
• Almost 1,000/person/yr in the U.S.
• 10 of a two-year olds nouns are brand names
• The average American can recognize over 1,000
  corporate logos, but fewer than 10 plants and
  animals native to his/her locality

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Corporations and Health

• The insurance industry
• The alliance between GE Medical Systems and
  NY-Presbyterian Hospital
• Global Tobacco Treaty
• The American Council on Science and Health
• Prison-Industrial Complex

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Pharmaceutical Industry

• Influence over physicians through control of CME,
  gifts, research funding
• Conduct seeding trials to alter prescribing
  patterns
• Secrecy, statistical torturing of data sets,
  selective publication

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Corporatization and Inequalities Threaten
Democracy

• True democracy demands an informed citizenry
  (education), freedom of the press (media), and
  involvement (will, time, money)
• Democracy is critical to public health

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Ignorance vs. Democracy

• Information is the currency of democracy
• Thomas Jefferson

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The Good News

• Rebirth of public health
• Political engagement of college freshman at
  all-time high
• International Treaties
• Montreal Protocol
• REACH
• Convention on Biological Diversitys draft
  protocol on biopiracy
• But problems are urgent.

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The Benefits of Sterility-Causing Chemicals in
the Workplace?

• 12 September 1977
• Dr. Eula Bingham, Assistant Secretary for
  Occupational Safety and Health Regarding
  worker exposure to DBCP. While involuntary
  sterility caused by a manufactured chemical may
  be bad, it is not necessarily so. After all,
  there are many people who are now paying to have
  themselves sterilized to assure they will no
  longer be able to become parents... If possible
  sterility is the main problem, couldnt workers
  who were old enough that they no longer wanted to
  have children accept such positions voluntarily?
  Orsome workers might volunteer for such
  workposts as an alternative to planned surgery
  for a vasectomy or tubal ligation, or as a means
  of getting around religious bans on birth
  control when they want no more children?
• Sincerely,
• Robert K. Phillips, National Peach Council

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What you can do (Enjoy yourself)

• Become active in an organization
• Educate yourself/others
• Use the media
• Volunteer, do pro bono work
• Satisfies your debt to society
• Feeds your soul
• Get politically active
• Run for office

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Power to the People, Not the Corporations

• Support living wage laws
• Restructure tax system
• Combat corporate crime

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Campaign for Fair and Representative Elections

• Publicly financed campaigns and campaign finance
  reform
• Proportional representation
• Instant runoff voting/cumulative voting/range
  (rating) voting

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Advocate for Womens Rights

• Increase access to comprehensive reproductive
  health services
• Combat domestic violence
• Eliminate female genital cutting

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SolutionsBased on the Precautionary Principle

• When evidence points toward the potential of an
  activity to cause significant, widespread or
  irreparable harm to public health or the
  environment, options for avoiding that harm
  should be examined and pursued, even though the
  harm is not yet fully understood or proven

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The Precautionary PrinciplePractical Essentials

• Give human and environmental health the benefit
  of doubt
• Include appropriate public participation in the
  discussion
• Gather unbiased, scientific, technological and
  socioeconomic information
• Consider less risky alternatives

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The Precautionary Principle in Action

• Montreal Protocol to phase out ozone-damaging
  chlorofluorocarbons
• REACH (Registration, Evaluation and Authorization
  of Chemicals)

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Save the Planet Together

• Combat environmental degradation and global
  warming
• E.g., reduce/reuse/recycle
• Support local economies and fair trade policies
• Encourage international cooperation

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U.S. International Non-Cooperation/Isolationism

• Failure to sign or approve
• Kyoto Protocol on Climate Change
• International Covenant on Economic, Social, and
  Cultural Rights
• Convention on the Prohibition of Anti-Personnel
  Land Mines

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U.S. International Non-Cooperation/Isolationism

• Failure to sign or approve
• Comprehensive Nuclear Test Ban Treaty
• Convention on the Rights of the Child
• Convention on the Elimination of Discrimination
  Against Women
• Convention for the Suppression of Traffic in
  Persons

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U.S. International Non-Cooperation/Isolationism

• Failure to sign or approve
• The Stockholm Convention on Persistent Organic
  Pollutants
• The Basel Convention on the Control of
  Transboundary Movements of Hazardous Wastes
• WHO International Code of Marketing of Breast
  Milk Substitutes

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Promote Fairness and Prevention

• Fight for more equitable distribution of medical
  research funds and health care dollars
• Focus on prevention
• 40 of US mortality due to tobacco, poor diet,
  physical inactivity, and misuse of alcohol
• Every 1 invested in community-based programs to
  increase physical activity, improve nutrition,
  and prevent tobacco use saves 5.60 in health
  care costs

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Work Together

• Never doubt that a small group of thoughtful,
  committed people can change the world. Indeed, it
  is the only thing that ever has.
• - Margaret Mead

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Contemporary Activist Organizations

• Physicians for Social Responsibility, Physicians
  for Human Rights, Amnesty International
• Union of Concerned Scientists, Public Citizens
  Health Research Group
• PNHP, Doctors without Borders, Doctors for Global
  Health
• Greenpeace, Sierra Club, HCWH, NRDC, ED, No Dirty
  Gold, PANNA
• Planned Parenthood, NARAL
• Others

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Speak Up for the Disenfranchised

• The first job of a citizen is to keep your mouth
  open.
• - Günter Grass

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First they came for the Jewsby Pastor Niemoller

• First they came for the Jews, and I did not
  speak up, for I was not a Jew.
• Then they came for the communists, and I did not
  speak up for I was not a communist.
• Then they came for the trade unionists, and I did
  not speak up, for I was not a trade unionist.
• Then they came for me, and there was no one left
  to speak up for me.

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Anita Roddick

• "If you think you are too small to have an
  impact, try going to bed with a mosquito in your
  tent"

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Contact Information

• Public Health and Social Justice Website
• http//www.publichealthandsocialjustice.org
• http//www.phsj.org
• martindonohoe_at_phsj.org