What we allow: health and policy

I can’t remember one childhood meal that didn’t begin with opening a package. Bright orange American singles individually wrapped in plastic, jars of salty red or beige sauce dumped into a one pot meal, the red string I pried off bologna slices and twirled around the plate until my mother urged me to hurry up and eat. A child of the early convenience era, my mother herself had been brought up on frozen TV dinners and canned soda. An 80s career woman, she loaded her hair up with Kenra 25 every morning and rushed me to the before-school program. By the time we made it home about 6:30 she didn’t have the time or patience to spend hours in the kitchen — she whipped up a box of mac and cheese with canned green beans, and argued with me about homework until bedtime.

One of my most vivid childhood memories is being in pain, all of the time.

The stomachaches were frequent and debilitating; I remember taking aspirin and ibuprofen as young as 8 years old and falling asleep doubled over on the couch in agony. It would take 40 years for me to discover that I have a sensitivity to gluten, and that other people do not have to excuse themselves after eating pasta to cry for an hour.

Humans have a way of becoming accustomed to circumstances that are not painful enough to inspire action — especially if the process of getting into that circumstance was slow and progressive. We will stay in terrible relationships, live in unsafe homes, accept subpar educational standards, and expose our children to the environment we have come to understand as “the way things are.”

When it comes to health outcomes, the willingness to keep on keepin’ on is exacerbated by the ability and social acceptability to manage symptoms; by a certain age, almost everyone we know is on blood thinners or glucose inhibitors and talking about achy joints. Almost everyone has lost someone close to them too young to preventable illnesses. Health hardships have become a norm we associate with aging, rather than with environment and behavior.

About 20% of our health outcomes are attributed to the medical care we receive; the rest are attributed to the “Social Determinants of Health,” including factors like economic stability, education, socialization, and access to care. Some of these are within our control, while others are heavily impacted by external bodies like local government or industry. Whether your neighborhood is walkable or not is important to your health but often out of your control. Whether your closest grocer offers local, organic, affordable produce is likewise incredibly valuable to your well-being but not necessarily something you can personally address. The food your mother offers you when you are a child might make you sick … but I assure you, to argue with your mother is wasted energy. Many parents are doing the best they are able with limited resources themselves.

My first opportunity to work in public health in a meaningful way came as Director of Community Health and Nutrition at a large and well-respected social service agency in Cedar Rapids. This role offered both the responsibility to operate one of the most critical programs for older adults in this country — Meals on Wheels — and the wide-open opportunity to pursue collaborative initiatives that would serve to improve public health in the community. My own background as a person who experienced over a decade of poverty as a teen mother gave me a perspective and an urgency to perform this work in a way that would be truly impactful to those who have limited options and resources.

We launched initiatives like Snap at the Market, supported child care programs by providing their nutrition, offered Summer Meals to kids whose parents — like my own mother — were out of the home working while the kids were home for the summer. It was also through this role that I had the opportunity to connect with the AARP Age Friendly Communities initiative, Cedar Rapids Complete Streets, and numerous other projects designed to support our friends and neighbors in achieving a higher standard of living.

It was at a Governor’s Conference on Public Health breakout session several years ago that I heard firsthand from a rural public health employee that the public health agency had to be “careful” about their statements, because the agricultural goliath in her region notorious for workplace injuries and illnesses spreading to the local community was also the only big employer in the county.

I thought about that quite a bit when reading the controversy over a report released by the Iowa Cancer Registry that seemed to pin Iowa’s rising cancer rates on alcohol consumption and spent zero time addressing the impact of agricultural or environmental toxins.

I also think about it when considering the impact of electing leaders who value corporate and economic interest as a primary driver — and its escalation a measure of success — to positions that place public health in their charge.

What is the net public gain of a CAFO that pollutes the water and air and contributes to rising cancer rates? What is the cost of cutting SNAP food benefits if we measure by the cost of future value long term health outcomes instead of by present value budget allocations? What do we gain by tiptoeing around the delicate sensibilities of industries that increase profits by contributing to the early deaths of our sisters? Our mothers? Our friends?

We absolutely have the opportunity and the responsibility to do the best we can to improve our personal health and well-being through all of the mechanisms within our control. I would urge each and every Iowan to include in that personal wellness plan the mechanism of the voting booth.

Sofia Martino is a Gazette editorial fellow. sofia.demartino@thegazette.com