Thursday, December 4, 2008

The Stories Behind the Numbers

When social science researchers look at a public policy issue, they usually find a number so telling or shocking that you have to stop and think about the stories behind it.

For sociologist Linda Burton, one such number stood out in a three-city study she directed that looked at how illness and disparities in access to health care and health insurance affect the poor’s ability to get and hold jobs and maintain wealth.

Burton and two other Duke faculty members presented research Tuesday in the kickoff event in the fourth-annual Provost Lecture Series. As Burton asked, “How healthy are the poor?” her evidence answered “not very.” Statistic after statistic indicated poor parents and their children both face numerous and interrelated physical and mental health issues that are major obstacles to their economic hopes.

One number, however, stood out. “When we looked at mental health issues for children, we found a growing number of ADHD and autism cases,” Burton said. “One of the saddest findings was of suicide among the youngest children. In our survey [of 2,300 families] we found five children under the age of 8 had either attempted suicide or expressed suicidal tendencies. That’s just not a number you would expect to see” among that age group.

For Burton, statistics of suicidal elementary school children among the poor is evidence of the difficult task ahead for President Barack Obama in trying to address health and income disparities in the United States. If the caregivers and the children in these families aren’t healthy, their pocketbook will suffer.

“If a mother has to make a choice between caring for a sick child and going to work, they’re going to care for the kid,” Burton said. That takes money out of their wallet and hinders them from holding a job.

Burton wasn’t the only one at the lecture Tuesday presenting statistics that surprised.

For the Nicholas School’s Richard Newell, who discussed environmental and energy policy, the number that stood out was that fact that 98 percent of the world’s transportation is based on petroleum fuels. Newell said that number says a lot about how far the world has to go toward changing its economies to more environmentally friendly energy sources.

“This is going to be a long-term effort,” he said. “You don’t turn economies around on a dime.”

In addition, political scientist Peter Feaver discussed American global strategy and challenges facing the Obama administration in maintaining American power and influence.

The Provost Lecture Series, “Policy Visions for a New Presidency,” will continue in the spring semester with five leading scholars picking up the discussion on all three of Tuesday’s topics. Population studies scholar Paul Ehrlich will deliver the first address Feb. 2.

Wednesday, December 3, 2008

RIP Titus, last of his kind

We have some very sad news from the Duke Lemur Center this morning: Titus, a 25-year-old Golden-crowned sifaka -- the last of his kind in captivity and one of the very last in the world -- died yesterday after surgery for a tumor.

The entire staff had turned out to say goodbye to him, as he had been at DLC for 15 years. His species is highly endangered because their entire habitat is smaller than Durham County and highly threatened. Only one surviving band of golden-crowns is known to exist in Madagascar.

See the DLC blog for photos and details:

Monday, December 1, 2008

Sick and Tired

Monday was the 20th World AIDS Day, but "celebration is such an odd word for it," assistant dean Michael Relf told a small brown bag session at the School of Nursing.

Today, an estimated 33 million people carry HIV, of which two-thirds are in sub-Saharan Africa, where Relf does much of his research. As the virus spreads most viciously among the poor, the uneducated, the young and the female, "we're seeing the epidemic start over," he said. Completely depressing.

His colleague, associate professor Julie Barroso, is studying the psychic toll HIV infection takes on American patients, many of whom have been living with it for ten years or more. She presented preliminary data from an ambitious NIH-funded study that is measuring a dizzying array of physiologic and psychosocial factors in a cohort of 128 patients over time. What they're looking for is some predictors of the debilitating fatigue that many HIV-positive people experience. So far, the physiology -- liver function, thyroid, testosterone, viral lode, CD4 cell counts, etc. -- doesn't correlate at all with fatigue. But the psychic factors -- experiences of trauma, PTSD, depression, anxiety, lack of social support, etc. -- are ALL correlated with fatigue.

But there it gets tricky: Do HIV patients experience fatigue because they've got this infection (and all that it symbolizes) lurking over them, or does their stressful, traumatic, unsupported past make them feel more poorly?
Relf pointed out that trauma in childhood and adulthood are themselves predictive of HIV-positive status.

Clearly, another case where an ounce of prevention would save untold lives and resources. The other bottom line: Society, here and in Africa, needs to treat more than the HIV patient's symptoms. "Each of us can do something," Relf said. "Even if it's just listening to someone."