A recent article in the daily news (Cigarette taxes lead to big drop in smoking) highlighted the success of high cigarette taxes in reducing the prevalence of smoking in South Africa, particularly among the poor and the young- the two most vulnerable groups in a population.

The direct relation between raising taxes on cigarettes and reduced prevalence of smoking is not a novel phenomenon.  Such increases in taxes have been implemented in different parts of the globe at varied points in time. It is quite straight forward- as the cost of smoking increases financially the number of people who smoke decreases.  Less people smoking is a good thing for everyone!

Is raising taxes on cigarettes the most effective strategy in reducing the prevalence of smoking? Should raising cigarette taxes be the sole area of our focus? Are they other determinants of smoking that scream for our attention?

When I first thought about this approach, it seemed fraught with contradictions. After all, aren’t governments benefiting from smokers by raising cigarette taxes? When smokers quit smoking, how does the subsequent reduced revenue stream affect government programs paid for by cigarette taxes? Don’t governments really need smokers to provide this tax money? If so, what incentive is there for them to try to reduce smoking rates?

In other words, governments win when they raise cigarette taxes and they lose tax money when smokers quit smoking.

Anti-tobacco advocates would argue that raising the tax of cigarettes drives down smoking rates, and generates revenue for anti-tobacco programs. How much of the cigarette tax money is going toward smoking cessation and prevention programs anyway?

I would argue that higher taxes might even encourage people to smuggle illegal cigarettes and avoid paying the tax. Raising taxes on cigarettes is no doubt an effective public health intervention to curb smoking rates and lead to a drop in smoking-related illnesses over time, which in turn reduces the health cost burden on states. However, it must not be the only way.

Tobacco is responsible for creating a vicious circle of poverty in the world, especially in developing countries. In developing countries, many of the poorest smokers spend significant amounts of their income on tobacco instead of basic human needs such as food, shelter, healthcare and education. In addition to the economic burden (both on individuals and nations) of treating smoking-related illnesses and the consequent lost productivity, tobacco farmers often become trapped in a cycle of poverty and debt after being forced to sign crippling contracts with the tobacco industry.

From a public health perspective, it is vital to also identify and focus on the various determinants of smoking initiation as well. Identification of these determinants will aid in understanding not just the economical factors but also the social and behavioral factors impacting smoking rates in developing countries.

There is a need to focus on designing multiple interventions to achieve not just a large drop in rates of smoking but also a sustained drop in smoking rates. The increase in cigarette taxes must just be one strategy among our repertoire of interventions.  Therefore, alongside policy changes, interventions must be designed to continue to focus on:

• Improving education and awareness
• Focusing on the susceptible groups within a population
• Restrictions on smoking in public spaces
• Banning of advertising, promotion and sponsorships
• Stringent Packaging requirements
• Tax smoke-less tobacco products (such as gutka, naswar and paan) together with cigarettes

Related Articles:

Dawn: Pakistan among top four countries with rising tobacco use

University of Capetown: Cigarette taxes lead to big drop in smoking

Dawn: New Tobacco Taxes to Boost Revenue, Discourage Smoking

Mexico, where surging obesity rates have leaders scrambling for answers, just took a radical step to beat back the tide of fat: High-calorie sugary soda ads are now banned from TV at times when kids are likely to be watching.

A novel idea you think?

In 2012, in the U.S., in New York City under former Mayor Michael Bloomberg, NYC  tried to take the modest step of banning extra-large sugary drinks — and preventing food stamp purchases of the swill. Both steps were invalidated by policymakers and courts.

To combat New Yorkers’ rising obesity rates, Bloomberg tried to prohibit sales of 16-ounce soft drinks in the city’s restaurants, movie theatres and street carts.  But you could buy one (or as many as you’d like) at a grocery store.  Or, for that matter, you could buy two 8-ounce soft drinks in restaurants, theatres or on the street – just not 16 ounce drinks.  Exempted from the ban were 16-ounce fruit juices, milkshakes, and lattes, though each of these could easily contain more calories than a soft drink. These contradictions contributed to the court decision that shot down the ban – though the big mistake was in trying to regulate consumer choice by government fiat.

The regulation of the serving size of SSB’s (Sugar Sweetened Beverages) would have been a positive move for New York City, one that would have induced behavior change. There is now substantial scientific evidence available that lend credence to the idea that limiting access to SSB’s or replacing SSB’s with sugar-free substitutes or water can help reduce obesity. However, such behavior change involving reduction in the intake of liquid calories from SSB’s will not be seen immediately but rather over time. Future studies following the implementation of this new policy in NYC might reveal the associated decrease in obesity and obesity related diseases.

There exist lingering concerns that consumers’ reaction to policies restricting access to SSB’s could have unintended consequences. Taxing of sodas could result in consumers buying fewer fruits and vegetables so as to afford soft drinks. Consumers might even purchase two glasses of SSB instead of one glass .  However, these actions would entail the consumers consciously and deliberately making those choices, which would adversely influence their health despite the government’s efforts to curb poor health outcomes. In entertaining the possibility of such counterproductive changes in consumer behavior in response to the new ban, it is important to also pay heed to the notion that, although, the current policy change may potentially not improve existing consumer behaviors; they will impact the choices of the generations to come. Future generations might not find the need or see the logic in purchasing two glasses of soda instead of one, if 16 ounces is the standard large serving. Hence, the banning of the sale of supersize sugar-laden drinks in restaurants and movie theaters by city health officials in New York City amid fervid criticism is in fact a positive step in the fight against obesity and obesity related disease.

It is further argued that, because there exist several factors driving the obesity epidemic, changing one facet is not worth engaging in. According to statistics, the consumption of SSB’s is the highest in low income neighborhoods, among young adults and those already classified as being obese.This puts these already vulnerable populations at a greater risk for disease and death. It must be understood that even though the consumption of SSB’s is just one factor, it does have a compounding effect when put together with lack of physical exercise, poor diet, stress, socio-economic and behavioral factors, and education. Therefore, it might be worthwhile to consider the socio-ecological framework and the pressures that act on individual choices in determining the effectiveness and validity of this ban.

Despite such concerns about the limitations of these initiatives, these policies can be viewed as a start in making attempts to regulate the aggressive practices of the food industry. The current restriction on SSB’s might serve to provide a strong impetus to develop future recommendations and policy decisions to not merely limit consumption of just SSB’s but perhaps also target industries involved in the production and sale of large serving portions of high calorie food, refined foods that use toxic chemical preservatives (many of which are carcinogens), and hormone enriched foods and drinks. Sodium nitrate, bromates, sulfites, Propylene Glycol, and Caboxymethylcellulose are a few examples of common chemical food preservatives that are in desperate need of regulation as they have been found to increase the risk of chronic diseases such as cancer and cardiovascular disease.

In the light of the growing global burden of chronic diseases, having the government step in to take action in addressing the current and future health and consequent economic catastrophe due to rising health care costs is commendable and must  hence be encouraged. The involvement of the government is viewed by consumers as an infringement upon their basic rights. But this view might change when studies following this ban reveal an improvement in health outcomes. It is important to acknowledge that the creation of permanent or long-term changes such as these in the existing food environment would influence long-term changes in body-weight of children and adults.

Policies related to the serving size of SSB’s, can be perceived as being synonymous to policies pertaining to seat belt laws, smoking ordinances, dumping chemicals into a stream bed and Labor Laws, which have all had huge impacts on the lives of the public and were all designed and created to save lives and prevent tragic outcomes.

NEWTOWN CREEK, BROOKLYN NY Newtown Creek runs between Queens and Brooklyn. The areas of Newtown Creek that I observed included intersections along Greenspoint Avenue, where the factories were closest to the contaminated waters-Van Dam Street, Review Street, Railroad Avenue, N. Henry Street (location of the Newtown Creek Waste Water Treatment Plant) and Kingsland Avenue. These observed areas of Newtown Creek are saturated with factories- new, old and abandoned. The Newtown Creek is a four mile long waterway that empties into the East River, and is surrounded by a mostly industrial corridor. That corridor has been the site of intense economic activity over the last 150 plus years, and in what seems an almost inevitable corollary, the site of intense pollution. Numerous factories (some of which were observed puffing fumes into the air) together with abandoned piles of waste make up the waterfront. The creek has been receiving the effluent of oil refineries, petrochemical plants, fertilizer and glue factories, sawmills, and lumber and coal yards that dot the shoreline– not to mention raw sewage.

Factories along the Newtown Creek shore © Samantha Kozikott

Factories along the Newtown Creek shore © Samantha Kozikott

At points along shoreline where the greenish-brown water smelt very foul, pipes dumping some sort of waste into the water were spotted.

Some sort of foul smelling waste being dumped into the water. ©Samantha Kozikott

Abandoned waterfront pilings . © Samantha Kozikott

Rusty factories and dilapidated buildings along the waterfront.
© Samantha Kozikott

The New York Times reported on one particularly bad oil spill by Exxon Mobil 57 years ago, estimated at between 17 million to 30 million gallons lost into the waterway and into the ground at Greenpoint. Efforts to clean up the contamination resting under the feet of residents have been going on for years, but will get an added boost now. Philip Musagass, a lawyer with Riverkeeper, told the Times, “The impact is more subtle than in the gulf. The spill is unseen, and it’s in an area that was industrialized and already polluted. But the waterway is severely stressed, and it’s not a functioning ecosystem anymore.” In the canal itself, the water is polluted, but the harder problem is that the sediment at its floor has been absorbing and accumulating toxins all this time. According to an EPA statement, initial tests found pesticides, metals and PCBs, as well as volatile organic compounds that can evaporate into the air. The detailed study that goes with Superfund designation will determine the specific cleanup methods, but they will probably include dredging the canal floor and transporting the toxic mess to a landfill in someone else’s neighborhood. The creek has taken 150 years to get into this state, and it will probably take at least 15 more to clean up. The State could not afford to undertake a thorough clean up of Newtown Creek, but the Superfund designation means that Federal authority will be brought to bear to force some of the historic polluters to foot the bill, which could be as much as $500 million. Some of businesses that will be targeted include BP , Exxon Mobil, National Grid, Chevron, and Phelps Dodge.

See videos of Newtown Creek here.

A TRIP TO GOWANUS CANAL, BROOKLYN, NY I recently took a trip to the Gowanus neighborhood in Brooklyn to visit its infamously polluted (and smelly) canal. After decades of controversy, the Environmental Protection Agency recently named the canal as a Superfund site—one of the few such designations in an inner-urban area. In its report, the EPA found that the Gowanus Canal “has become one of the nation’s most extensively contaminated water bodies,” with contaminants including “PCBs, coal tar wastes, heavy metals and volatile organics.” Built in the 1860s by expanding a local creek, the Gowanus Canal quickly became a major industrial hub for Brooklyn and New York and was the home to numerous oil refineries and chemical plants as well as the repository for countless combined sewer overflows in rainstorms. As early as 1893 The Brooklyn Eagle called the canal “an open cesspool,” so one can only imagine what it was like a hundred years later. A flushing tunnel was installed in 1911, but was closed in the 1960s after the flushing propeller was damaged. The canal lay stagnant for nearly three decades before it was finally fixed. My observation of this superfund site included observing areas closest to the water of the Gowanus Canal – 1st street, 2nd street, 3rd street, 4th Street, 6th street, Union Street Bridge, Court Street, Degraw Street and Douglas Street. So what is the waterway like? It’s hard to do justice in pictures. When I was there,the stench of the dark brown water, covered in thick, black, oily sludge was nauseating. This distinct odor was prominent in spots where noxious fumes were emitted from pipelines and waste of some sort was being dumped into the canal in addition to the random bits of rubbish—I can say for certain it didn’t look like a great place for a swim. There were signs posted by the EPA all along the shore prohibiting swimming, fishing and boating as well as highlighting the toxic nature of the water and soil. Piles of abandoned wastes (rubber tires, metals scraps, plastics etc.) were a common site. It’s said that before the resumption of flushing in 1999, the canal was so polluted that there was no life at all under the water.

Rubber tires, plastic traffic cones, pieces of metal found floating in the canal. ©Samantha Kozikott

Black oily sludge on the surface of the water.
©Samantha Kozikott

Abandoned barrels of waste floating in the water

The Gowanus Dredgers Canoe Club sign highlighting the mission of the club- “providing waterfront access and running education programs for the public along the shorelines of Gowanus, Red Hook and DUMBO” was seen mounted along the shore. The presence of several bright yellow bird houses on either side of the canal (Degraw Street) was spotted. Signs posted explained that these bird houses were designed to attract certain species of birds and was part of an initiative called the Canal Nest Colony started in 2008. The mission of this project as stated on the sign was “to encourage human-nature interaction, plant and animal biodiversity and highlight the diverse ecosystem potential of the Gowanus Canal”.

Amid the toxic water of the Gowanus Canal and the consequential environmental health risks that lurk, lies the Dredgers Canoe Club sign that reads “WELCOME TO THE GOWANUS CANAL, BROOKLYN’S COOLEST SUPERFUND SITE” © Samantha Kozikott

Bright yellow bird houses along the canal.
© Samantha Kozikott

In theory the designation means that those industries and groups responsible for polluting the waterway—including most prominently the U.S. Navy, the City of New York, Con-Edison and National Grid—will be forced to help pay for an estimated $300 to $500 million cleanup. New York City had fought the designation , arguing that stigma of Superfund would tarnish the reputation of the neighborhood, making redevelopment more difficult. The City also said it had a more efficient plan. Now, though, everyone is pledging to work together on the cleanup. The city has fully re-activated the Gowanus Canal’s on-again, off-again flushing tunnel after a four-year, $177 million rehabilitation.The city will also be reactivating a pumping station in June to improve water quality. It’s interesting to note what’s going on in the rest of the neighborhood, which has become one of those fascinating, dynamic New York places where housing projects sit next to yoga studios and art galleries. Now that a real cleanup finally seems to be underway,could this waterway be transformed from filthy, polluted eyesore to a major magnet for urban revitalization?

HUDSON RIVER , BATTERY PARK, NY The 315-mile Hudson River is steeped in American history. It guided Henry Hudson in search of a northwest passage and served commerce as a transportation route during the Industrial Revolution. Industry provided jobs, created communities, and brought economic growth to the region. However, an era of industrial pollution left its mark on the treasured river. Today, 200 miles of the Hudson River is classified by EPA as a Superfund site – one of the largest in the country. Today the Hudson River exists as one of the most extensively studied rivers in the country, having been monitored almost continuously for a period of more than 25 years. Ongoing evaluations of water quality, sediment, air quality, fish, and wildlife by the Federal Government and the State of New York have demonstrated that the river is not cleaning itself and PCBs in the sediment pose a serious risk to human health and the environment. Studies conducted to evaluate the extent of the problem in the (years) revealed that most of the contaminated sediments were in “hot spots” situated in a 40-mile stretch of the river between the town of Fort Edward and the Troy Dam. Despite the greenish-brown color of the water, there was the absence of floating debris and detectable odor in the air. Joggers, dog walkers, children playing in the park, tourists taking pictures and people eating along this waterfront were common sites. NYC water taxis and ferries run in these waters all day long. While people engaged in recreational activities along the walkways and parks along the waterfront, traffic ran relentlessly on the roadways adjacent to the Hudson River.

Battery Park, NY- The color of the water is greenish brown. Ferries and NYC water boats are observed running all day long on the Hudson River.

In February 2002, EPA issued a Record of Decision (ROD) for the Hudson River PCBs Superfund Site that calls for targeted environmental dredging of approximately 2.65 million cubic yards of PCB-contaminated sediment from a 40-mile section of the Upper Hudson River. Read more about the Hudson River cleanup and view project documents. These superfund sites highlight the damage we have done to our environment in New York.  Not only does the natural environment suffer, but human health is compromised by being surrounded by toxins in the air, earth and water. Let’s hope this trend toward doing something about it will continue. Even more, let’s hope it helps industry, policy makers and citizens alike recognize how much cheaper it is to not pollute in the first place, than to have to apologize and clean up later.

Check out this video posted by the World Bank called “Making Maya Cry” which emphasizes why health systems matter.

This video posted by the World Bank called “Making Maya Cry” (see below) stresses on the importance of health systems and reinforces the need for the identification of the various determinants of health, followed by the establishment and implementation of effective measures and procedures to ensure that successful health systems are in place to meet the desperate health care needs around the world. In addition, it must be noted that there exists a stark difference in the overall attainment of improved health service when comparing the adoption of a “Health Systems /Systemic Approach” to the adoption of a “Disease/Service Specific Approach” (2). The strengthening of existing health systems would serve to provide a stable and long-term solution by working on the root causes of diseases/conditions as compared to the more immediate and short-term solutions proposed by the “disease specific approach (2).”

Health systems play a vital role in achieving key health goals. It is thus necessary to establish a structure that not only measures the performance of various health systems but also permits acknowledgement of major policy challenges. The performances of health systems vary from country to country due to differences in design, content, management procedures, income, education and health expenditure (4).

According to The World Health Report 2000, performance of a health system should be centered on the accomplishment of three primary goals: “improving health”, “enhancing responsiveness to the expectations of population”, and “ensuring fairness of financial contribution” (1,4). Murray and Frenk have contributed in expanding upon the aforementioned goals by elaborately describing the major components of responsiveness and fairness. Measuring the responsiveness of a health system according to these authors, includes focusing on a number of factors “dignity, confidentiality, autonomy of individuals and families to decide about their own health, quality of basic amenities, choice of provider, prompt attention, and access to social support networks”(4). Measuring the fairness of financial contribution entails focusing on the notion of “fair share” which stresses that, poor households should be protected from the costs of ill-health and disability by ensuring that they contribute less of their income towards health care in comparison to the rich (4). This would prevent them from compromising on basic needs of food, shelter and education and being pushed into further impoverishment (1, 4). Fairness in financial contribution is important in ensuring reduction in the inequity in availability of health care. Furthermore, the authors suggest that the existence of variation in performance depends on the manner in which health systems organize the functions of stewardship, financing, service provision and resource generation (4).

Effective health systems are pivotal in ensuring the attainment of improved health. The constant monitoring of performance is imperative in measuring progress and implementing changes when necessary. Given that well designed health systems have the potential to reduce inequity in distribution of health care services, should health systems primarily be founded on the principle that everyone has the right to healthcare irrespective economic status?

References
1. Skolnik Richard. (2008). “Essentials of Global Health”

2. World Health Organization.“ Health Systems Strengthening”. (2011).http://www.searo.who.int/linkfiles/rcphd_fs2.pdf

3. Baeza Christian. (2011). “Making Maya cry: why health systems matter.”http://blogs.worldbank.org/health/making-maya-cry-why-health-systems-matter

4.Murray, Christopher and Julio Frenk. “A Framework for Assessing the Performance of Health Systems”. Bulletin of the World Health Organization.Vol 78, Issue 6. 2000. 717-729.

Copyright Samantha Kozikott

There has been a huge shift of money and power from the United Nations (especially the two primary multilateral institutions –WHO and World Bank) into the hands of the “New Colonialists” / “New Players” i.e. international charities, aid agencies, philanthropists, and foreign advisers (2). The lack of UN support from its member states can be viewed as the core reason for this massive shift. It has resulted in dwindling of financial resources and hence the UN’s limited initiative in undertaking problems that are too ambitious and costly. The new players in comparison have continuously expanding budgets enabling them to address key issues quickly and efficiently thereby gaining the trust of host countries. The UN on the other hand suffers from loss of trust and support of not only the host countries but also donor countries.

Corruption is a noteworthy factor to be considered in this evident shift. The WHO lends to governments, thereby allowing the state to continue to play the central role in health policy while the new players control the movement of aid directly from donors into the hands of NGO’s at the receiving end thereby bypassing host governments. The loss of vital donor aid to rampant government corruption in developing countries is mitigated in the case “new players” enabling them to actually achieve set goals more efficiently and effectively. This movement of aid reflects the lack of donor confidence and their resulting support in the new players instead of in the UN.

Over the last several years these new players have succeeded in increasing the dependency of host countries. Decreased authority and responsibility of host countries is directly proportional to the increased dependency and empowerment of the new players. Increased dependency is preventing the host countries from becoming more responsible and playing an active as opposed to a submissive role in developing policies and ensuring effective channeling of aid. However, the existence of raging corruption, lack of knowledge, expertise, experience and manpower makes it hard to not acknowledge the need of the new players.

Should attempts to reform and eventually strengthen the multilaterals (WHO and World Bank) from within with the end goal of limiting its dependency on the new players be considered? Should the UN establish more accountability into its system to resolve the issue of lost confidence given that accountability varies depending on the perspective of the stakeholder?

References:

1.Michael A Cohen; Maria Figueroa Küpçü; Parag Khanna. “The New Colonialists.” 2008. Foreign Policy; Jul/Aug 2008; 167; ABI/INFORM Global .pg. 74

2. Devi Sridhar. “Seven Challenges in International Development Assistance for Health and Ways Forward.” 2010.Journal of Law, Medicine and Ethics.

The global controversy and mass hysteria, particularly in the United States, centered on the health effects of Bisphenol A (BPA), an industrial chemical invented nearly 120 years ago has lasted several decades. There are concerns about the effects of the production and use of BPA and its follow-up products on the environment. Numerous studies by scientists, opinions of environmental activist groups and politicians, and publications by journalists confirm the existence of a public health threat. However, these views are contradictory to those of major international authorities such as, the European Commission, the European Food and Safety Authority (EFSA), the US Food and Drug Administration (FDA), the Japanese Ministry of Health, Labor and Welfare, and the World Health Organization (WHO).

In the midst of these relentless and powerful debates, wrapped in controversy, and fueled by aggressive media coverage, where do the consumers stand? Whom should they believe? What choices are best for them? What is the industry not telling them? These questions have left the consumers in a state of unremitting panic and utter confusion. The debate over BPA has further added to the list of the decisions to be made to live healthy: expensive organic foods or cheaper chemically processed foods, soy milk or whole milk or almond milk, tuna or salmon, Splenda or Equal, and the list goes on. It is necessary to look at the views of different stakeholders and their impact on consumers and the choices consumers make.
Bisphenol A (2, 2-bis(4-hydroxyphenyl) propane, CAS No. 80-05-7), a monomer also commonly referred to as BPA, is an industrial chemical that is used in the production of polycarbonate (PC) and epoxy resins. At a global consumption level of over 95% for PC and epoxy resins, it is one of the most widely used chemicals in the world (14). BPA is present in food contact materials: infant feeding bottles, tableware, microwave ovenware, food containers including those used for infant formula, water bottles, milk and beverage bottles, processing equipment, water pipes, protective linings for canned foods and beverages, as a coating on metal lids for glass jars and bottles, adhesives, dental fillings, medical devices, and recently in point of sale receipts at fast food restaurants, grocery stores, gas stations, post offices, and automated teller machines. The levels and patterns of consumer exposure to BPA vary, but oral exposure from the diet is the primary cause of concern. However, the level of concerns, or in some cases even the acknowledgement of the mere existence of concerns regarding BPA consumption, varies in the opinions of the different stakeholders involved.

The reason BPA has sparked numerous debates and scientific studies, as well as extensive media coverage, is that this chemical, which was earlier categorized as a weak environmental estrogen, is now defined as a known human endocrine disruptor, similar in potency levels to estradiol in its ability to stimulate a myriad of molecular and cellular pathways in the human body (8). This chemical has been found to leach into food and water from polycarbonate containers. According to a study conducted by the researchers at the Harvard School of Public Health, BPA migration from polycarbonate bottle use increases at extreme temperatures, indicating a higher dose intake when consuming food or beverages from hot or cold containers (3). Over the years, as a result of both in vitro and in vivo studies, BPA exposure has been linked to adverse effects on the male reproductive system, such as the effects on male sex hormone levels, androgen receptors, and organs such as the testes, epididymis, sperm, seminal vesicles, the prostate gland, and sperm production (15). Additionally, reported adverse effects include the early onset of sexual maturation in females, altered development and tissue organization of the mammary gland, induction of pre-neoplastic mammary gland and reproductive tract lesions (3), risk of chronic disease development (such as, cardiovascular disease, diabetes, and obesity due to metabolic disorders resulting in alterations of insulin/glucose homeostasis and liver enzymes)(9), carcinogenicity, genotoxicity, acute and repeated dose toxicity, immunotoxicity, neurotoxic, neuroendocrine, and neurobehavioral effects (1,15,10,5). Even though BPA has the potential to cause harm in all age groups, the more vulnerable groups in the population are pregnant women, infants and children (5).

From the perspective of scientists and researchers of the world’s leading academic and governmental institutions in the fields of endocrine disruption, endocrinology, neurobiology, reproductive biology, genetics, and metabolism, BPA must be regulated.

In stark contrast to the deductions of scientific experts, international regulatory bodies have repeatedly declared BPA to be a safe chemical. Their deductions are based on separate risk assessments and government reviews conducted by individual countries worldwide. Risk assessments conducted by Germany (German Federal Institute of Risk Assessment Bundesinstitut für Risikobewertung- BfR), UK (Food Safety Authority –FSA), France (Agence nationale de sécurité sanitaire de l’alimentation, de l’environnement et du travail- ANSES), Spain (Agencia Espanola de Securidad Alimentaria y Nutrición- AESAN), Switzerland (Bundesamt für Gesundheit- BAG), The Netherlands (Voedsel en waren autoriteit –VWA), Denmark (Danish Minister for Food, Agriculture and Fisheries and Danish Environmental Protection Agency,) Ireland (Food Safety Authority), USA (Food and Drug Administration- FDA), Canada (Government of Canada and Health Canada), New Zealand and Australia (Food Standards Australia New Zealand FSANZ) and Japan (National Institute for Advanced Industrial Science and Technology-AIST) reached the same consensus that “human BPA exposures are low and within safe limits set by government authorities (4).” These major regulatory bodies worldwide have discounted many of the scientific studies conducted on the basis of “lack of sufficient evidence,” “no clear effect,” “still an emerging area of research,” “design and data analysis issues that limit utility,” “no health concern at current low dose levels,” and “considerable uncertainty regarding the validity and relevance of these observations (2, 12).” Previous studies have been criticized for focusing too much on injected effects of BPA on the body instead of on the effects of oral consumption, as ingestion is the primary mode of transmission of BPA into the body (2, 12).

In the light of these two strongly opposing views, the matter still remains unsettled and the world continues to be obsessed with BPA. Despite decades of continuous research by scientists, resulting in the production of a vast array of studies covering a dizzying range of potential ways BPA might be toxic to humans and the relentless assurance by major government agencies, the tension and turmoil created by the health effects of BPA has still not ended. News reports, media coverage and scientific publications continue to surface for this environmental estrogen. The decision of several states and local governments in the US (Minnesota, Chicago and Connecticut in 2009, Washington, Wisconsin, Massachusetts, Maryland, New York and Vermont in 2010), as well as of governments worldwide (Canada in 2008; Denmark in 2010; China; all of the EU and Malaysia in 2011) to ban BPA in products for infants, especially baby bottles, is contradictory to their original claim that BPA is safe.

However, the fact that BPA does in fact leach into food and beverages is undisputed between these two opposing groups of thinkers. It is the level and existence of severity that is disputed. BPA is claimed to be safe for human consumption as the dose levels are very low and because it has a half- life of less than 6 hours, allowing it to be excreted from the body nearly completely within 24 hours (3).

Despite claims of BPA being safe for human consumption, there are certain elements of concern and unresolved questions that continue to lurk and must be contemplated upon and perhaps addressed in the future. The effects of not only continuous and widespread exposure to BPA but also the potential effects of BPA interactions with other synthetic chemicals in our environment and diet should be considered. This is important because chemical interaction with BPA may result in further manifestation of the impact of BPA exposure several fold no matter how low the dose might be. Additionally, given the ubiquitous nature of BPA, individuals might be subjected to multiple exposures of BPA on any given day. For instance, the exposure to BPA starts for many with the first cup of hot morning coffee, the paper receipts handed out at retail stores and dollar bills used to pay, drinking of bottled water during the day, and eating take- out for lunch served in styrofoam boxes that are BPA reserves. Again, as individuals are not exposed solely to BPA but several other synthetic chemicals, the morning coffee is more than just coffee and requires plenty of forethought as a consumer. It is a milieu of unidentifiable chemicals and toxins- coffee (organic grown or chemically processed?), milk (are there synthetic hormones present?), sugar (Is it chemically processed?) and the infamous BPA.

The BPA controversy has encouraged consumers to use alternate materials that are BPA free. Since there is no single replacement for BPA; the new alternative plastics involve replacement of BPA with chemicals such as polypropylene, polyethersulfone, polyethylene terephthalate, high-density polyethylene, PVC, polyamide, silicone, Tritan copolyester, polyesters, polyacrylates, vinyl resins and oleoresins. However, what if its replacement turns out to be more toxic? BPA has been subjected to extensive research to arrive at present day conclusions and a partial ban of its use by countries worldwide, but the new replacements are yet to be put to the test. So, should consumers now be more concerned? Should uncertainty in findings of health effects of BPA be translated to no health risks? Is this trade-off worth making?

Comic Strip highlighting the constant dilemmas of ” us” – The Consumers

REFERENCES
1.Allsopp Michelle, Santillo David and Johnston Paul. 1997. “Poisoning the Future-Impacts of Endocrine-Disrupting Chemicals on Wildlife and Human Health.” 1997. Available at: http://archive.greenpeace.org/toxics/reports/ptf/ptf.html

2.Butterworth Trevor. 2009. “Science Suppressed: How America became obsessed with BPA.” STATS Investigation. Available at:

http://stats.org/stories/2009/Science%20Suppressed_%20America’s%20Obsession%20with%20BPA_June30_09.pdf

3.Carwile Jenny L., Luu Henry T, Bassett Laura S, Driscoll Daniel A., Yuan Caterina, Chang Jennifer Y., Xiaoyun Ye, Calafat Antonia M., and Michels Karin B. 2009. “Polycarbonate Bottle Use and Urinary Bisphenol A Concentrations.” Environmental Health Perspectives. Volume 117;number 9.

4.European Information Center on Bisphenol. 2011. “The safety of Bisphenol A-based consumer products – what the authorities say.” Available at:http://www.bisphenol-a-europe.org/uploads/EN_Regulatory%20Assessments.pdf

5.Houlihan Jane, Lunder Sonya, and Jacob Anila. “Timeline: BPA from invention to Phase-out.” Environmental Working Group. 2011.
Available at: http://www.ewg.org/reports/bpatimeline

6.Huang YQ, Wong CK, Zheng JS, Bouwman H, Barra R, Wahlström B, Neretin L, Wong MH. “Bisphenol A (BPA) in China: A review of sources, environmental levels, and potential human health impacts.”2011. Environmental Int. 10.1016/j.envint.2011.04.010.

7.International Food Safety Authorities Network (INFOSAN). “BISPHENOL A (BPA) – Current state of knowledge and future actions by WHO and FAO”. 2009. Available at: http://www.who.int/foodsafety/publications/fs_management/No_05_Bisphenol_A_Nov09_en.pdf

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Copyright UNICEF

The burden of stunting exists worldwide. However, most people have never heard of stunting. Stunting is one of the least reported, least recognized and least understood issues facing humanity today. Stunted growth, wasting and being underweight are all consequences of undernutrition. However, stunting affecting 165 million children under five years old (one out of every four.), presents itself as a problem of greater magnitude than wasting or being underweight.

The increased nutritional needs and greater vulnerability of children puts them at the greatest risk of stunting and mortality when they lack access to a diet that meets all their nutrient needs. However, in addition to decreased fetal nutrition during pregnancy and child nutritional deficiencies there are several other factors that cause stunting either directly or indirectly- poor sanitation and hygiene, poverty, teenage pregnancy, maternal dieting, poor health care, poor knowledge and care practices, uterine vascular problems and frequent attacks of infectious disease. Prevalence of undernutrition exists in both developing and industrialized countries but to different degrees and in different forms.

Stunting or low height for age, caused by chronic undernutrition in children, does not only affect a person’s growth or height. It causes irreversible damage to physical and cognitive development, especially during the first two years of a child’s life. It presents both short-term and long-term consequences.

Stunting prevents children from growing up to live long and productive lives. The lack of access to an adequate diet during the first 1,000 days between conception and age results in poor brain development, IQ, and scholastic achievement in school-age children leading to future income reductions as adults. The effects of stunting are irreversible, long term and intergenerational. Impaired intellectual development, infectious diseases and chronic diseases such as cardiovascular diseases, obesity and diabetes further exacerbate poverty through lost wages and increased health care costs that further hinder earning capacity. Therefore, stunting traps people into a vicious cycle of poor nutrition, illness, poverty and inequity, holding back the development of not just individuals but entire societies and nations at large.

So, how to win this battle against undernutrition and stunting? Given that undernutrition has a range of immediate, underlying and basic causes, efforts to tackle it must be multi-disciplinary and engage multiple stakeholders. The designing of program interventions must include:

•Promoting the use of micronutrient and vitamin supplements

•Raising awareness that children throughout the world can achieve their growth potential. The common misconception is that children belonging to certain ethnic and racial groups are “naturally” short.

•Promoting exclusive breastfeeding

•Treating severe and acute malnutrition

•Including measurements of height, not just weight in routine program evaluations: Policymakers should be encouraged to use stunting as an indicator of overall child health and nutrition, rather than monitoring only being under¬weight to circumvent the complexities of the “nutrition transition”- a growing trend leading to populations with high rates of overweight, low rates of underweight but persistently high rates of stunting.

•Improving access to education and safe drinking water, promoting hygiene, preventing and treating diseases, and strengthening social safety nets.

Proper nutrition helps give every child the best start in life. Tackling the issue of stunting should be viewed as an opportunity both for personal health and national development. Children should not be condemned to a life of deprivation – especially when we know how to prevent it.

Check out this video by UNICEF on the First 1,000 Days of a Child’s Life

Copyright Samantha Kozikott