What’s Next? The Uncertain Future of Healthcare in America

What’s Next? The Uncertain Future of Healthcare in America
by Kaitlyn Rice and Mercedes Li

This article was originally published in the Fall 2016 print issue.

On November 6, 2016, the country awoke in shock to find that their 45th president would not be the first woman president as so adamantly expected, but rather the first president in recent history with no political experience and with few concrete policy ideas. Because of the lack of media coverage on the candidates’ policy proposals in favor of scandals, during the year and a half campaign, there is much uncertainty as to what a Donald J. Trump presidency means for a multitude of policy issues, including healthcare.

In the Time of Trumpcare

Though one of Trump’s fundamental campaign pillars was to repeal Obamacare, this will prove much more politically difficult than he originally anticipated. To begin with, he will require a supermajority of 60 senate votes to overturn the Affordable Care Act (ACA) in its entirety, and a simple majority of 50 votes to eliminate certain provisions, which could prove difficult even with a Republican House and Senate majority. If Trump were to repeal the ACA with no clear replacement, more than 20 million people could lose healthcare coverage, likely blaming the GOP and his presidency. In fact, over half of Americans either want the ACA to remain the same or to expand.

According to the Wall Street Journal, after “further review”, Trump now intends to keep the requirement that a patient cannot be denied care due to a pre-existing condition and the provision that allows young adults up to 26 years old to remain on their parents’ health plan. However, if Trump intends to repeal other parts of the healthcare law, such as the individual mandate, which has historically been unpopular with Republicans, it is very possible that the entire system will unravel. The healthcare mandate is what incentivizes healthy and young people to participate in the insurance market, who otherwise may not have bought coverage. The participation of healthy people in an insurance market is vital for its success, as it balances the financial risk of all the unhealthy and older people who have chronic, and often expensive, conditions.

Not only does a partial revocation of the ACA threaten the system itself, but it will also likely cause premiums to skyrocket. An existing criticism of Obamacare is the high prices, due to lower than expected participation of healthy people, so eliminating the individual mandate will only lower the participation further. The sicker the average patient in a risk pool is, the more expensive the premium will be. Trump therefore has to decide whether he wants millions of Americans to lose coverage, prices to soar, or to go back on his word to repeal Obamacare.

According to the GOP website’s healthcare plan, they may intend to leave the majority of the administrating and managing of healthcare programs up to individual states, including the low-income program, Medicaid. Even under Obamacare, 19 (mostly red) states failed to expand Medicaid to reach more patients, mainly low-income adults. More state autonomy with regard to healthcare could result in less funding for Medicaid in Republican states, where at least 3 million people that qualify for the program under federal standards already lack insurance. Since subsidies are largely unpopular with the Republican party, they too could be in danger, and threaten to further decrease the number of insured Americans. Other GOP proposals include allowing health insurers to sell insurance in different states, with the hope that interstate competition may reduce costs, and making insurance premiums tax deductible.

If Trump and the GOP decide to completely repeal Obamacare, California could be one of the states most affected, largely because it enrolled more people than any other state. 1 in 3 Californians are now covered by Medi-Cal, California’s program for low-income patients, which was greatly expanded under the ACA. California has also not faced the rise in insurance premium prices that other states have seen and the exchange Covered California has been able to offer residents a variety of insurance plan options. As Sabrina Corlette, from Georgetown University said, “The ACA has not been perfect, there have been challenges. [But] if there was one state where it was really working well…it was California”.

With the repeal of the ACA and without federal funding of the exchanges and Medi-Cal, California could lose $20 billion for these programs. And although California leads the way on many social issues, it will likely be hard to do so without the federal funding and structures to provide health insurance to the millions of Californians who so desperately need it. However, if Trump only partially repeals the ACA and gives states autonomy through a block grant, which is more likely, the state will still be able to offer insurance, though will have much less funding to do so. With a much smaller budget, there are legitimate worries of reduced services or reduced number of insured patients, which could have detrimental effects for many families.

thumbnail With much at stake in both California and across the nation, it is imperative that we remain as politically active as possible, to demonstrate both the value of the ACA, and its federal funding, in the goal of ensuring every American has access to quality healthcare.

Kaitlyn is a fourth-year double majoring in Public Health and Spanish language. She is interested in health management and policy, specifically how languages and cultures affect the delivery of healthcare in different nations. Currently, she is Co-Editor-in-Chief for PHA, is involved with Zeta Tau Alpha Fraternity and is a member of Cal UPHC. She hopes to one day use her Spanish and Portuguese language skills to improve efficiency, cost control, and access to healthcare both in the United States and around the world.


Leaving Us Behind

One public health issue that has garnered less public attention than the call to repeal Obamacare, but may still have important implications for millions of Americans in the labor force, is that of paid parental leave. Currently, the United States is one of the three countries in the world that does not have a national law mandating paid maternity or paternity leave, the other two being Papua New Guinea and Suriname. The 1993 federal Family and Medical Leave Act and the California Family Rights Act provide for up to twelve weeks of unpaid leave per year to take care of a newly born, adopted, or fostered child, or for an immediate family member or themselves because of a serious health condition. But because of stringent eligibility requirements only about 60 percent of the American workforce is covered.

On the statewide level, Rhode Island, New Jersey, and California are the only states to provide paid parental leave, with California’s Paid Family Leave (PFL) program allowing workers to receive weekly cash benefits for six weeks of out of a year at approximately 55 percent of earnings up to a maximum of $1,129. In the past year, San Francisco also passed a bill mandating fully paid parental leave for new parents, including same-sex couples, who bear or adopt a child, with the 45 percent difference paid by employers.

Trump is the first Republican presidential candidate to address the growing need for a national paid family leave policy. His plan, outlined on his website, provides for six weeks of maternity leave to new mothers, at an average of $300 in weekly benefits. Even though providing paid maternity leave seems like a much-needed step forward for national policy, there are significant shortcomings in Trump’s plan.

First of all, the financing of paid leave would amount to billions of dollars, which Trump has proposed paying for by eliminating unemployment fraud. Using the average $300 per week benefit, Trump’s proposed plan is estimated to cost $2.5 billion annually. Yet this means that female workers on average would receive about 38.7 percent of their usual pay when on maternity leave. If the government opts to increase the wage replacement rate for mothers on leave and employers don’t provide paid leave, then the costs increase to $10.2 billion in the first year and $122.0 billion over ten years to provide this benefit. Unemployment fraud in the United States is estimated to cost only $3.3 billion a year.

thumbnail Maternal leave following the birth of a child is crucial for the health of newborns and mothers. Studies show that infant mortality rates fall and cognitive development improves when a newborn is cared for by their parent full-time. Bonding and trust are established between parent and child during this critical time, and the physical and psychological tolls of pregnancy also mean that those who give birth need more than just four or six weeks to recover from pregnancy and labor. A six-week-old baby is just barely able to lift its head, which is why 86 percent of countries that offer maternal leave provide more than 12 weeks.

Donald Trump’s daughter, Ivanka Trump, has said that the policy would be meant to benefit a married mother who gives birth to a child. Yet providing paid leave only for new mothers also overlooks much of the complexities of work and parenting in the United States today. Same-sex couples, single fathers, adoptive parents, and foster parents won’t receive any of the benefits of the proposed maternity leave plan. Women would be incentivized to take time off work at a higher rate than men, likely placing them in the “mommy track” in the eyes of employers, which can lead to fewer promotions and raises, further widening the gender gap. Not providing paternity leave as well enforces the discriminatory myth that women should be the primary caretakers of children, discouraging men from sharing the work of childcare and housework and investing time and energies in parenting, especially in the crucial early months of life. Two-thirds of men say they also want an equal role in parenting, and this policy would not make it easy to do so.

While establishing a national plan for six weeks of paid maternity leave would be a step towards the right direction, doing so without clear plans for funding, a length of leave fully benefitting a child’s growth and development, or establishing equal leave for fathers, same-sex couples and couples would shortchange women, children, and families. Establishing paid parental leave on par with other high-income nations of the world would help ensure that the United States is not left behind in terms of health and wealth, achieving equality and wellbeing for all.

Mercedes is a senior majoring in Public Health and Psychology, and is currently Co-Editor-in-Chief for PHA and External Vice President of the Cal Undergraduate Public Health Coalition. After graduation, she hopes to embark on a career within health management or health policy, to improve patient care and lower healthcare costs. She also enjoys musical theater, hiking, baking, and collecting vintage-style postcards.

PHA Fall 2016 Online Staff Feature

PHA Fall 2016 Online Staff Feature

This article was originally published in the Fall 2016 print issue.
We asked our online writers and editors: What are your career aspirations in relation to the field of public health? What public health issues do you hope to make a difference in in the future?

thumbnail ELIZABETH LI – copy editor
There are so many areas of public health that interest me, but I am especially considering health management or policy. I’m also drawn to medicine, specifically pediatrics. Regardless of what I end up doing, my main goal is to help others and to leave a lasting impact. In the future, I aim to coordinate health resources to effectively prevent and stop the transmission of diseases. Right now, I’m interested in learning about the social and biological determinants of health. I hope to utilize this knowledge in the future to influence policy.

thumbnail NOAH FOROUGI – writer
I’m interested in the international aspect of public health, and I have always wanted to be involved in organizations like the World Health Organization or the Center for Disease Control and Prevention. I hope to work with on the ground efforts in areas impacted by public health emergencies. With recent outbreaks of Zika and Ebola, there is a great need for leaders in the international community to attack these issues head on. I hope to be a part of this effort to combat international, large-scale public health crises and make tangible impacts.

thumbnail SOPHIE MA – writer
I aspire to pursue a career in medicine as a primary care provider and integrate aspects of public health in my career for treatment and diagnoses. In the future, I hope to make a difference in improving health disparities in the community by helping underprivileged patients receive adequate care with a variety of affordable programs and training for other health care providers.

thumbnail BRANDON CHU – copy editor
Right now, I’m interested in learning about the social and biological determinants of health. I hope to utilize this knowledge in the future to influence policy. In the future, I aim to coordinate health resources to effectively prevent and stop the transmission of diseases.

After graduating from UC Berkeley with an undergraduate degree in public health, I hope to work for the CDC on preventative measures for reducing the spread of various diseases that plague our society today. Additionally, I hope to connect public health and medicine by pursuing a medical degree along with an MPH. I hope that my knowledge of public health will give me a new take on medicine. I believe that mental health is an important issue that people must address in order to lead successful and happy lives. I am also passionate about community health and human development – specifically the role nutrition plays in leading a healthy lifestyle. I hope to bring light to these issues in my future endeavors.

Immunity in the College Environment

Immunity in the College Environment
by Kristal Lam and Heather Zhang

This article was originally published in the Fall 2016 issue of The Public Health Advocate.

Every year, students leave for college and say goodbye to their parents, often resulting in an additional farewell to their health. Without their parents’ constant nagging to take vitamins and dress warmly, many college students end up prioritizing other tasks over their own health.

Homesickness isn’t the only sickness spreading; the flu and the common cold find themselves attacking anyone they can. Each cough, each sneeze, spreads infectious droplets that can cause the whole floor to become sick. Trash cans pile up with used tissues while roommates buy new jugs of hand sanitizer. Chamomile tea is depleted from the store shelves, and tissues boxes are emptied.

Ninad Bhat, a student coordinator for Unit 1’s Health Workers Program, admits that “the most common vector of illness is other students.” Whether this means living with other people or sitting next to the sick kid in class, microbes are spreading among the student population. Luckily, there are many ways to prevent these illnesses from making an impact on one’s own health. According to Bhat, proper sleep, personal hygiene, and proper nutrition alone are already enough to maintain the strength of one’s immune system.

However, in the case that one does get ill, it is important to receive proper treatment. While the common cold and flu may resolve themselves within a week with the help of over-the-counter drugs, they present with symptoms that may also imply a greater viral or bacterial infection. Conveniently, the Tang Center on Bancroft is open to all registered students, regardless of insurance, and it provides services by board-certified physicians to get students back on a healthy track.

Unfortunately, those popular frat parties that a majority of students experience at some point during their college careers are an entirely different environment. Isabella Brandes, student coordinator for PartySafe@Cal, an organization hosted by University Health Services, “focuses on mitigating the risk of over-intoxication and alcohol poisoning by engaging and educating party hosts and attendees to implement safety measures to protect their attendees.” Over-intoxication and alcohol poisoning can also be considered illnesses in that they affect body systems and can lead to the inability to do typical tasks. In these circumstances, immunity refers to the ability to stop oneself from giving into the peer pressure and consuming alcohol in large amounts.

Cold, clammy skin. Unresponsive or unable to be roused. Slow breathing. Puking repeatedly or uncontrollably. CUSP is an acronym provided by the Health Workers Program for students to keep in mind whenever alcohol is present as these are signs of severe alcohol poisoning. PartySafe recommends calling medical assistance if someone is seen with these symptoms, and in the meantime, rolling the victim on his/her side with the mouth propped open will prevent choking. In cases of impairment without the symptoms of poisoning, fluids and non-salty carbohydrates are effective for recovery.

Through various preventative measures, common illnesses can be avoided. As Bhat explains, “The best way to stay healthy when surrounded by people you don’t know is to get to know them and work together to prevent illness.”

Kristal is a first year studying biochemistry in L&S. She’s passionate about health and wants to go into neonatal care in the future. Kristal enjoys skateboarding, finding new places to eat, and watching The Fosters on Netflix.

Heather is a first year with an intended major in Public Health. She is living in the moment and exploring her interests before figuring out what she wants to do in the future. In her free time, she enjoys eating while watching Grey’s Anatomy and taking long naps.

Does Denmark Have a Better Healthcare System than Us?

Does Denmark Have a Better Healthcare System than Us?

A Comparison of Health and Infrastructure in the U.S. and Denmark

by Arianna Maysonave

This article was originally published in the Fall 2016 issue of The Public Health Advocate.

Life, liberty, the pursuit of happiness – fleeting remnants of the American dream, a dream existing in essence but often not in actualization. Now more so than ever, this dream makes grand promises but questionable deliveries, especially for those residing in the ever-growing margins of society.

We are a country ridden with internal turmoil, plagued with economic crises, battling deeply ingrained race and class-based discrimination. A society of strength and global dominance, a country unafraid to assert that dominance, yet unwilling to take care of its citizens on a fundamental level.

Today, the United States remains the only industrialized country in the world that fails to provide universal healthcare for all citizens. A complicated system presently begging for reform, American healthcare is the source of innumerable issues for many – both those with and without coverage. These issues are not limited to the domain of health care, but rather ripple out, with far-reaching influence on quality of life, psychological stability, and fundamental happiness for society at large.

Now, let’s paint a very different picture. Imagine a place of equity and inherent trust, of civility and interdependence rather than competition and angst. Visualize unlimited access to adequate healthcare, high standards of living, and generalized harmoniousness between people and state. Think of free education, sufficient maternity leave, and a culturally promoted balance between work and life. Add 4.5 million bicycles to an already people-centric society, and you have Denmark! A small, rather unassuming Northern European nation notoriously known for being the “happiest country in the world,” Denmark is clearly doing something very, very right.


In seeking solutions, politicians and citizens alike often look abroad, contemplating possibilities for progress and the implications they may bring. Circumstances are obviously always different, but modifying existing systems often lays effective groundwork for creating tangible change. After spending a semester in the heart of Copenhagen, Denmark’s bustling bicycle capital, I can vouch for the rudimentary differences between America and Scandinavia. The divergences extend beyond policy, go farther than logistics or political agendas – there is a different feel to the place, a different tone to the culture on a fundamental level.

It can be argued that universal healthcare as a core principle of Danish society is both a byproduct and a cause of its optimal functioning. People are taken care of – that’s clear – but there exist other embedded cultural elements (extending beyond the domain of healthcare) that contribute to the overarching wellbeing we observe. Understanding how these structural elements create an environment of prosperity, ease, and mental wellness is paramount in addressing the struggles facing American society.

However, it is important to understand that Denmark, a small, relatively homogenous country of 5 million, will never compare to the U.S., a multicultural mixing pot of nearly 320 million. The specific structure of Danish society may not be replicable on a grand scale, but the tenets it stands for can certainly inspire us to move in a positive direction.

A Northern European archipelago of over 400 islands situated within the Baltic and North Seas, Denmark is defined by deeply rooted principles of solidarity, egalitarianism, progressiveness, and collectivism. Their welfare model declares that all citizens have equal rights to social security, ensuring that healthcare and education are free for all citizens. Access to these rights are achieved through relatively high taxation, which is supported rather than resented, as citizens understand that their contribution to welfare is essential to its functioning.

Denmark’s welfare system plays a central role in mediating affairs between citizen and state. The system is built on trust, both in each other and the government – 90% of Danes vote, and participation in politics is considered crucial in the maintenance of democracy. Conversely, only roughly 50% of Americans participated in the recent controversial presidential election, a statistic reflecting the apathetic state of the U.S. populace.

U.S. Senator Bernie Sanders uses Denmark as a prototype for how America could be if democratic socialism were to become a reality. He applauds how Denmark’s foundation of economic security is conducive to happiness, and remarks that the deep-seated distrust in the American government is a core struggle facing the US as a whole. As Karen Christensen, Copenhagen native, explained, “The Danish people may appear happier, but this is a direct result of our society’s social security net – it just takes off pressure on a day to day basis.”


Egalitarianism is a central pillar of Danish society – equal rights for all people is central, and the theoretical divides between rich and poor or woman and man are not deterministic in projecting quality of life. Christensen mentions, “This is a place where you have to be clever and determined to attend the best schools, but not necessarily wealthy.” Women are respected in the workplace, and entitled to at least four months maternity leave and flexible hours to ensure a manageable work-life balance.

It has often been alleged that Denmark’s approach to harmonizing work and leisure is paramount in maintaining their high quality of life. The pace of life in Denmark is slower and more intentional than that of its distant American relatives – stress levels are lower, and the overarching burden to perform is much less prominent. There is less focus on financial earnings or economic status, and the tendency for arrogant ambition is frowned upon in Danish society. Compared to countries like the U.S., there is less pressure to ascend the esteemed hierarchy of success – achievement does not denote value, and thus the need to succeed is self-driven rather than socially embedded.

Simone Thirstup-Andersen, a Danish student currently studying abroad at UC Irvine, explained that “having free education, universal healthcare, and a bike-based society are paramount,” and that “Danes have every reason to be happy because they have innumerable opportunities if they choose to take them.”

These cultural values undoubtedly contribute to varying levels of mental health issues – expectations are different, services are more accessible, and society as a whole is not writhing in a state of economic, social, and political flux. Another element of Danish society that reflects its people-centric prioritization is the structure of its cities – Copenhagen is built first for humans, and second for bicycles. People from all strata of society participate in cycling, which is seen as both an environmentally conscious and healthy alternative to driving. More than half of citizens, ranging in age from children to seniors, use bicycles as their main mode of transportation. Pedestrian centered urban development and intentional use of public space empower the populace to both embrace and participate in their immediate environment.

Meanwhile, governed by auto-industries and corporate lobbying, the United States caters to the car, not the person. In most major cities cycling is dangerous, and the urban sprawl of suburbia has left many regions of America disconnected by roadway expanse. For many, this limits access to resources, and separates people from place in a very literal way. Christensen explained that “the difference between infrastructure in Denmark and in other places is the fact that is available for everyone, it greatly impacts the creation of equal opportunity to all.”

photoIt is undeniable that mental health promotion is critical in creating and maintaining a happy, productive populace. However, without necessary infrastructure, this goal cannot be achieved. There are plentiful ways to approach the multifaceted changes America presently demands – from revolutionizing urban planning to guaranteeing universal healthcare, from shifting the unrealistic work-life balance to making real steps toward equity for the masses, not the few. These aspirations are enormous, multifaceted, and challenging to implement. But we must start somewhere, and emulating the ideals of Denmark may be just the place.

Arianna is a 4th year Public Health and Psychology double major, Food Systems minor. She finds joy in the great outdoors and is happiest when on the trail experiencing the diverse beauty of the natural world. Arianna loves writing, yoga, baking, and farmers markets, and will never turn down a spontaneous adventure. Traveling makes her feel especially alive, and she hopes to spend time abroad experiencing the richness of other cultures after graduating college.

Interview with a CDC Epidemiologist

Interview with a CDC Epidemiologist

Dr. Snigdha Vallabhaneni currently works as a medical epidemiologist at the Center for Disease Control. She received her undergraduate and medical degrees from Brown University and received a Masters of Public Health from UC Berkeley. This interview was conducted by Vedaja Surapaneni, business managing editor for PHA, and was published in the Fall 2016 print issue.

Q: How did you become interested in public health?

A: Growing up in India, I was keenly aware of many infectious diseases, including diarrheal illnesses, dengue and malaria, after falling ill with one of these infections myself. Those experiences got me interested in becoming a doctor, but when I realized that there was more to treating those infections than medications – that is was really a clean water supply, good sanitation, and vector control that would really make a difference for these types of infections, I began to appreciate the value of public health. As I learned more about all the different areas of health, that public health interventions could impact, including mental well-being, chronic diseases, dental health, and infectious disease, to name a few, I decided that a path in public health was the right one for me.

Q: What is your role at the CDC?

A: I am a medical epidemiologist (in other words, a medical disease detective) in the fungal diseases branch. I investigate outbreaks of fungal disease around the world, conduct surveillance to understand the burden of fungal diseases, and conduct epidemiologic studies to understand why certain people get certain types of infections while others don’t, so that we can understand how to prevent disease.

Q: How does public health feature in your role at the CDC?

A: CDC is public health practice 24/7. Almost everything I do there has to do with protecting the health of the public.

Q: What is the value of public health education to you?

A: It was the Masters programs in Public Health at Berkeley with Dr. Art Reingold that actually got me to think like a disease detective. I learned about he methods and techniques used in epidemiology to ask the right questions and answer them using the right methodology. It has been invaluable in my day-to-day practice of public health.

Q: What advice do you have for undergraduates that are pursuing public health?

A: Do it! There are so many ways you can apply your education to make the world a better place. The possibilities are endless.

The Health of the Homeless

The Health of the Homeless
by Simran Bajwa

This article was originally published in the Fall 2016 issue of The Public Health Advocate.

Any student, faculty member, staff member or visitor to UC Berkeley can easily see the vast amount of individuals experiencing homelessness. Southside, the area of Berkeley directly south of the university campus, is home to a large proportion of the city’s homeless population, who live in People’s Park or on the sidewalks of Telegraph Avenue. Anyone who frequents Downtown Berkeley sees many more people sleeping on Center Street, Shattuck Avenue, and University Avenue. Once one leaves the city limits of Berkeley and ventures into Oakland, San Francisco, or even farther into San Jose or Vallejo, it becomes apparent that the problem is not a Berkeley problem. It isn’t even an East Bay problem. It’s a Bay Area problem.

As the San Francisco Chronicle deemed a decade ago, the homelessness issue in San Francisco is “the shame of the city”, which still holds true today. In summer editorial pieces, writers and readers from around the Bay Area have suggested solutions such as tracking programs to place individuals in programs that fit their unique needs, instead of grouping everyone together. Another common suggestion was to identify and house first the most at-risk individuals, who often end up in hospitals.

thumbnail Very often, when discussing the homeless problem, we forget that they all are humans, with basic human needs. We speak of the need to find them shelter or provide them with clean water and sufficient nutrients from food. But the homeless also require basic medical services and treatment. They are very vulnerable to diseases and infections that the rest of the population can prevent or treat easily. They are more likely to fall into harmful habits. And they are just as likely to develop mental illnesses.

Jon Marley, MPH, works part-time for the Berkeley Free Clinic’s Information and Resource Collective. He states that one of the most-used resources the Clinic offers is free STD and STI testing. Marley also believes that sexually transmitted diseases and infections are some of the biggest health issues facing the homeless community members today.

Dr. Margot Kushel, a Professor of Medicine at UCSF, states that there is a higher prevalence of mental health disorders among individuals who experience homelessness than people who do not. However, while many people believe that large proportions of the mentally ill homeless population have psychotic mental disorders, Dr. Kushel states that depression, anxiety, and PTSD are much more common.

In order to alleviate the negative health effects that homelessness can have on individuals, Dr. Kushel states that the best step is to first house them and then work on treating any other conditions. This approach is the most common nationwide, since having shelter and food/water security allows individuals to focus on getting healthier instead of worrying if they can eat that night or where they will sleep.  Unfortunately, nationwide, only 1 in 4 individuals who qualify for housing assistance receive it.

In the Bay Area, there is also an additional barrier: expensive housing. When the housing is as expensive as it is in the Bay Area (the median monthly rent for a 1-bedroom apartment in San Francisco is $3,590) it’s very difficult for people to use their Section 8 vouchers, even if they are able to get their hands on one. The government will pay for the rest of the voucher user’s rent (up to $2,000) after that person has spent 30% of their monthly income on it. In much of the Bay Area, housing is so expensive that to pay enough of the rent for the government to provide aid means an individual would have to find a very stable, well-paying job, often a difficult task for an individual experiencing homelessness.

So, besides giving individuals who experience homelessness Section 8 vouchers, what else can be done to help better their health? Dr. Kushel explains that across the Bay Area there are a number of homeless outreach services, in which volunteers, as well as trained physicians, treat homeless individuals on the streets. She adds that another great method is respite care. 

Oftentimes, individuals who experience chronic homelessness also have larger amounts of health problems. These individuals go from the streets, to an ambulance, to hospital beds, and to the streets again, only to repeat this cycle later. The ambulance rides and hospital visits are often paid for with taxpayer dollars, and this cycle often does not help the chronically homeless in the long run.

Respite care seeks to break this cycle by offering members of the homeless population temporary shelter as well as some medical services. For example, an individual might have to go to the hospital to receive treatment, but instead of waiting for full recovery and then going back onto the streets, that person can then be discharged sooner into a shelter where there are nurses present.

Why does the health of the homeless population matter? First, the cost of paying for individuals who experience homelessness to repeat the cycle of ambulance rides, hospital care, and living on the streets is a large waste of money. And living on the streets and not being happy, healthy, or productive towards a goal is a waste of a life. From both a rational, economic perspective and from a moral or public health perspective, it is crucial that we understand the severity of the homelessness health problem and work to create a solution.

To get involved: contact the Berkeley Free Clinic, the Suitcase Clinic, or other local homeless outreach programs to volunteer clinically. Contact your local city governments to help participate in homeless counts, and contact your representatives in Congress to push for investment in affordable housing.

Simran is a second-year student with an intended public health major. Besides being a writer for the Public Health Advocate, Simran is a peer health blog writer for the University Health Services Tang Center and is a member of the Undergraduate Public Health Coalition. She is interested in studying the intersection of public policy and medicine and one day hopes to be a physician.

Pass the Dressing!

Pass the Dressing!

Transmission of Antibiotic Resistant Genes via the Consumption of Food

by Joy Suh

This article was originally published in the Fall 2016 issue of The Public Health Advocate.

Think back to the last time you had a salad. You probably had a bowl of lettuce, some spinach thrown in there along with some of your common market veggies (shredded carrots, tomatoes, cucumbers), and topped off with crunchy croutons, crispy chicken strips, and your favorite dressing drizzled on top. As you take that first bite, the last thing on your mind is the possibility of antibiotic resistant saprophytes living on your spinach. Yes, you read that correctly. Allow me to explain.

automatic_flow_vegetable_packaging_machine_and_gl2400_heat_shrink_machineSaprophytes are plants, fungi, or microorganisms that live on dead or decaying organic matter. Some have been found to possess what are called antibiotic resistant (AR) genes which give microbes, such as bacteria, the power to resist normal antibiotic treatments and cause serious infections.

Dr. Lee Riley has been studying the link between ingesting foods with saprophytes containing AR genes and the development of AR pathogens within the body’s microbiome. In 2011, Dr. Riley, Eva Raphael, and Lisa K. Wong published a paper in the Applied and Environmental Microbiology journal of the American Society for Microbiology titled “Extended-Spectrum Beta-Lactamase Gene Sequences in Gram-Negative Saprophytes on Retail Organic and Nonorganic Spinach”. They took saprophytes found on the spinach, cultured them, and then sampled 165 random colonies from the total 231 that were cultured.

From the samples they tested, they identified 20 known species of drug-resistant gram-negative bacteria (GNB), a group of bacteria known to have a double membrane making them more resistant to antibiotics such as penicillin. GNB who possess antibiotic resistant genes are capable of passing on those genes to other GNB or even bacteria outside of their own species through a process called horizontal gene transfer. Thus, those antibiotic resistant genes could end up inside bacteria, such as E. coli, that live within our gut. The paper’s abstract concluded, “…saprophytes in common fresh produce can harbor drug resistance genes that are also found in internationally circulating strains of GNB pathogens; such a source may thus serve as a reservoir for drug resistance genes that ultimately enter pathogens to affect human health.”

It’s a scary prospect to think about. But it forces us to consider the risks of global food distribution. Now, no one is about to suggest that we stop global food trade all together. But for countries like Japan who rely heavily on imported food to feed their people, the spread of antibiotic resistant genes via food is no laughing matter.

In a 2011 interview published in the Berkeley Science Journal, Dr. Riley recognized this potential threat: “Japan is a major food importing country, and so they have major problems with all these drug resistant infections.” At the time of the interview, Dr. Riley’s lab was also investigating the possibility that infections specifically in the urinary tract involving AR E. coli could actually be a food-borne disease. Just this past October, Dr. Riley’s lab received a $560,000 grant from the Center for Disease Control and Prevention (CDC), which will coordinate with them on researching how diet influences the development of AR E. coli in the gut, which could increase the risk of women contracting urinary tract infections (UTI), a disease commonly treated with antibiotics.

shutterstock_85763107Dr. Riley’s research includes collecting urine samples taken from the Tang Center from women who have UTI. The E. coli in the urine is then isolated from the samples and screened for ampicillin resistance, an antibiotic used to treat UTI. If the E. coli show resistance to ampicillin, they are then tested for resistance to other antibiotics. A urinary tract infection occurs when bacteria, usually E. coli reigning from the large intestines, travel up the urethra into the urinary tract where they begin to multiply unchecked. The infection eventually spreads to the bladder and can progress to the kidneys, causing a more serious infection known as pyelonephritis if left untreated. Symptoms of pyelonephritis include back pain, vomiting, fever, painful urination, and bloody urine. From the kidneys, UTI can then enter the blood stream, spreading the infection throughout the body.

A reported 10 million Americans are infected with UTI every year, the vast majority being women; one in five women will contract UTI at least once in their lifetime. Common symptoms of UTI include a burning sensation when urinating, feelings of achiness, pressure or pain in the abdominals, and pungent urine. Treatment usually involves prescribing antibiotics to the patient. However, for someone who may be harboring an AR bacterial infection, antibiotics are rendered ineffective, which can complicate treatment and recovery.

The CDC is well aware of this growing problem concerning antibiotic and multidrug resistant pathogens. This year alone, Congress set aside $160 million to fund CDC’s efforts to curb antibiotic usage and fund research; all of this is outlined in the National Action Plan for Combating Antibiotic-Resistant Bacteria. Dr. Riley’s lab was one of 34 projects who received a portion of the total $14 million the CDC dispensed to fund research projects across the nation.

In a recent interview with Dr. Riley, he talked with PHA about his research on UTI as well as some of the social concerns surrounding food-borne infections. “UTI is the most common bacterial cause of infections in women. Until now, people have only considered food borne disease to be associated with diarrheal illness, but if it is associated with UTI and blood stream infection, especially for women, it’s a huge impact.”

Joy is a first-year student intending to major in Public Health. She is interested in studying infectious diseases, epidemiology, and green energy sources such as biodiesel and solar power. She is a member of Cal UPHC as well as a copy editor and writer for PHA. In her free time, Joy pens short stories, plays the violin, and spends time with friends. She hopes to earn an M.D. and open her own practice or pursue a career as a medical researcher.