All posts by Deborah Binder

Climate Change: How to Lose and Save Lives

The Environment

“Climate change could kill more than 500,000 adults in 2050 worldwide due to changes in diets and bodyweight from reduced crop productivity, according to new estimates. The research is the strongest evidence yet that climate change could have damaging consequences for food production and health worldwide.”

– Marco Springmann, Daniel Mason-D’Croz, Sherman Robinson, Tara Garnett, H Charles J Godfray, Douglas Gollin, Mike Rayner, Paola Ballon, Peter Scarborough. Global and regional health effects of future food production under climate change: a modelling study. The Lancet, March 2, 2016 DOI: 10.1016/S0140-6736(15)01156-3

The authors predict that, compared to a future without climate change, climate-change related reduction in fruit and vegetable intake could lead to an extra 534,000 deaths, mostly in China and India. This is the worst-case of the four scenarios used by the authors. Their message is we’ve got to get more serious about climate change.

The challenge is to find solutions that don’t lead to more lives lost than saved. For instance, policies that decrease global GDP in any significant way would increase mortality rates. Ditto for policies that make it hard for small farmers to diversify into a broader range of farm and nonfarm activities. And policies that make it harder to adopt GM crops will reduce food security, calorie consumption, and dietary quality for billions.

Additional References:

Salvador Pérez-Moreno, María C. Blanco-Arana, Elena Bárcena-Martín. (2016) Economic Cycles and Child Mortality: A Cross-National Study of the Least Developed Counties. . Economics & Human Biology.

Peter Hazell. Five Big Questions about Five Hundred Million Small Farms. Paper presented at the IFAD Conference on New Directions for Smallholder Agriculture 24-25 January, 2011

Qaim M, Kouser S (2013) Genetically Modified Crops and Food Security. PLoS ONE 8(6): e64879. doi:10.1371/journal.pone.0064879

Denmark: an Unemployed Worker’s Paradise?

Politics and Economics

Summary so far: Denmark has an extensive safety net and high taxes. As per usual, the situation is a lot more complicated than the buzz. Last time we looked at the health care system. Now we’re going to take a closer look at unemployment benefits.

You’ll read on Bernie Sanders website that in Denmark, a worker can receive unemployment insurance covers up to 90 percent of earnings for as long as two years. Sounds great – but of course the situation is more complicated. As it turns out, the unemployment benefit maxes out at the American equivalent of $2230 per month (compared to a max of over $4500/month in California). So it’s a good deal mostly for low-income workers.

But the Danish government makes it hard to enjoy the benefit for long. They have this thing call an “activation program”, which is kinda like harassing someone to get back to work: you know, like having to see a job counselor and getting referred to job openings, which if you don’t accept, your benefits get cut for awhile. And that’s why the average duration of unemployment in Denmark is all of 4 months and the unemployment rate is just 6.3%.

The Self-Control Triad

Explorations Outside the Box

Self-control operates much like a cybernetic feedback system and includes 3 interacting components: the setpoint, a discrepancy, and the correction (or reduction of discrepancy). In order to successfully exercise self-control, one must have a setpoint (where do I want to be: a goal), detect discrepancies between where am I now and the setpoint, and then have the ability to reduce or eliminate the discrepancy. Put simply: self-control requires a goal, an obstacle, and the ability to overcome the obstacle.

Self-control training must target all three parts of the triad.

Of course, it’s more complicated than that. Everything is more complicated than a few sentences.

References:
Michael Inzlicht, Lisa Legault, and Rimma Teper , Exploring the Mechanisms of Self-Control Improvement. Current Directions in Psychological Science 2014, Vol. 23(4) 302–307.

Cziko, Gary The Things We Do: Using the Insights of Bernard and Darwin to Understand the What, How and Why of Behavior, published by MIT Press 2000.

Accepting and Redirecting

Observing Mindfulness

To “accept” a thought that just unfolded and then to redirect attention to something else is a type of shallow processing. It’s like listening to the first few notes of a song and then turning your attention to something else – all you can really say is you heard a few notes, not the entire song. What you’re really doing is accepting little notes of thoughts. If you’re already pretty sure where those notes lead to and you don’t want to listen to the rest of the song, then there’s no need to listen to the whole thing. But acknowledge that this is “acceptance” writ small. What is being accepted is a taste, not the whole enchilada.

Of course, thoughts aren’t just a string of  words – thoughts  bob along on seas of emotion. So part of what is being accepted is the emotion that carries the thought along. Actually both are carrying each other: the words support emotions and emotions support the words.

But then, “bobbing along” makes thoughts sound like inert objects. Another way to think about thoughts is as directional behaviors – going towards something, whether toward a solution to a problem, the next step on the way to a desired outcome, further self-clarification, or an effective comeback in a re-imagined conversation: a resolution of some sort. In this sense, a thought’s meaning is also in its “actionable” implications.

Of course, thought-streams often peter out before resolution of their concerns and new subjects take over, sometimes in a matter of seconds. That doesn’t mean that thoughts are inherently inert – only that the wind in their sails blows with variable force. A weak breeze won’t sustain the course for long. And the reality outside our heads keeps asserting itself.

Willpower and the Big Picture

Explorations Outside the Box

Kelly McGonigal defines willpower as “the ability to do what you really want to do when part of you really doesn’t want to do it.” It consists of three competing elements: 1) I will – the ability to do what you need to do; 2) I won’t – the other side of self-control; the inability to resist temptation; and 3) I want – your true want, the ability to remember the big picture of your life.

Often when we castigate ourselves for impulsive actions, we  say we weren’t “thinking”. I interpret that as saying we weren’t considering the Big Picture. We were operating on a concrete level, not thinking beyond the moment.

Reference: McGonigal, K. (2012). The willpower instinct: How self-control works, why it matters and what you can do to get more of it. New York: Avery.

A Case for Hope: Conservation Practices by US Farmers

The Environment

Conservation Practices-US Farmers

This chart is from the USDA Economic Research Service.  It shows that US farmers consider the environmental effects of agricultural production, e.g., soil erosion and the loss of sediment, nutrients, and pesticides to water, and have adopted conservation practices to mitigate these effects.  Use of such practices has increased substantially over the past 20 years. Farmers will continue to adopt conservation practices when it’s affordable.  Luckily, government programs promote adoption rates by helping defray costs. There is reason to hope.

Red Flags of Bad Science and Pseudoscience, Part II

Observing Mindfulness, Scientific Encounters

These Red Flags and their definitions are from the website Science or Not? The examples and comments are mine.

Stressing status and appealing to authority: “People who use this tactic try to convince you by quoting some ‘authority’ who agrees with their claims and pointing to that person’s status, position or qualifications, instead of producing real-world evidence. The tactic is known as the argument from authority.”

I’ll be relying on Jon Kabat-Zinn to illustrate this Red Flag. Kabat-Zinn is a well-known Mindfulness advocate. All examples here are from:  Jon Kabat-Zinn, Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness, Kindle Version, Revised Edition 2013; Bantam Books, New York).

Throughout Full Catastrophe Living, Kabat-Zinn uses markers of authority and status to sell his message. Here are some examples (all pages numbers are for Kindle; underlines and comments are mine):

“A recent headline in Science, one of the most prestigious and high-impact  scientific journals in the world, read: ‘A Wandering Mind is an Unhappy Mind’. 346

           “Norman Cousins, the prominent magazine editor and leading intellectual…” 7846

  “…the highly respected television journalist, Bill Moyers, had his own body burden      of toxic chemicals tested.” 8759

  “…the highly respected economist Jeffrey Sachs has recently made an impassioned   and well-argued case in his book The Price of Civilization that mindfulness needs      to be at the heart of any attempt to resolve the major problems we face as a   country, and, by implication, as a world.” 9275

“The modern terminology for biological wear and tear is allostatic load, a term      introduced by Bruce McEwen, a renowned stress researcher at Rockefeller  University.” 5354

 Kabat-Zinn occasionally uses technical terms like “allostatic load” to confer scientific respectability to his assertions. His use of “the modern terminology” is interesting: makes it sound like there is one modern terminology that serves as an authoritative standard.

“Some doctors believe that time stress is a fundamental cause of disease in the present era.” 7811

This is one of those statements that give an aura of authority (“Some doctors”) but which is so vague you don’t know what to make of it. Who are these “doctors”? Are they researchers? Epidemiologists? Medical doctors? Doctors of Theology?

“Pioneering work over more than thirty years by Dr. Dean Ornish and his             collaborators…. has consistently demonstrated that by changing your lifestyle      [including meditation, yoga, and a mostly vegetarian diet]…you can slow down,   stop,   and even reverse the progression of severe coronary heart disease as well as     early-    stage prostate cancer.” 8697

[For a little balance on Dean Ornish, check out:  www.scientificamerican.com 2015-4-22 Why Almost Everything Dean Ornish Says about Nutrition Is Wrong]

 

Thoughts: Guests at the Party of Your Mind

Observing Mindfulness

Think of thoughts as guests at the party of your mind. Imagine being at a family gathering and the relatives are a talkative bunch. You are “observing” the scene not as a detached bystander but as a loving, involved family member. You catch snatches of conversation, some not that interesting, some best to ignore. But you’re watching out for someone who may benefit from your attention (Granddad looks confused) or maybe someone is saying something that you want to pursue, then you listen and maybe even get involved in the conversation.

You might want to correct someone’s misstatement, or maybe just listen and give them support because you feel what they’ve saying might be important to them. You engage in active listening: trying to sense the feelings and intentions behind what the other person is saying, trying to understand their meaning, sometimes, asking questions or trying to steer the conversation to “bring them out” because you sense that they’re working out an understanding or idea and might need a little patience and encouragement.

Uncle George is always spouting his opinions about politics at these gatherings. You like to argue with him, because he welcomes disagreement and vigorous debate and doesn’t seem intent on winning the argument at all costs. Sometimes these arguments with Uncle George help you see things a little differently and you’re grateful for the learning experience. Sometimes you even manage to change his mind.

On the other hand, you avoid arguing with Aunt Irva. She complains about the same things over and over and there is no use trying to talk her out of her opinions.

Like Aunt Irva, there are always a few relatives at these gatherings who seem to be endlessly kvetching about something. You find yourself wanting to talk them out of their bad moods but past experience tells you that’s a losing proposition. You’ll just get entangled and never convince them of their wrongheadedness. In fact, trying to talk them out of their opinions can only make matters worse – like fanning the flames of a fire.

At the same time, you love these relatives and talking with them can be rewarding when they’re not in one of their moods. Sometimes they’re more receptive to gentle persuasion than other times. They are not a lost cause. You want to maintain a relationship with them, and that means paying some attention to them at family gatherings, regardless of what’s in it for you. So, you go over and listen for a while, nod occasionally, but simply not engage with their complaints.

You might find that by simply listening and acknowledging, but not agreeing or arguing, Aunt Irva will eventually calm down. The fire of righteous anger will slowly burn itself out. The clouds of her bad mood will dissipate.

Some thoughts are like endlessly kvetching relatives. Engaging with them only encourages them, regardless of whether the engagement is supportive or resistant. But not all thoughts are problem relatives and problem relatives aren’t always pointless to engage.

The Denmark Model: Healthcare

Politics and Economics

Summary so far: Denmark has an extensive safety net and high taxes. As per usual, the situation is a lot more complicated than the buzz. So we’re going to take a closer look, starting with the health care system.

As previously advertised, Denmark provides “universal health care”. What does this mean? It means “primary health care” is available to everyone. It doesn’t mean that health care it totally free. Most patient still have co-payments for things like medication and physical therapy. And it doesn’t mean you get to see whomever you want, at least if you’re counting on the government paying. For instance, if you want to see a specialist, a general practitioner has to make the referral (much like the Kaiser Permanente system).

Denmark does do a good job of containing healthcare costs, at 11% of GDP, compared to 17% in the US. The government has reined in costs through economies of scale and the elimination of malpractice litigation (replaced by a national system of modest compensation for medical mistakes). Under this system, there’s less incentive for doctors to over-refer, over-test or over-treat. The budget for physician salaries is smaller because GPs are paid less than specialists and most doctors in Denmark are GPs (80%, compared to just 31% in US). Further savings result from the extensive use of non-physicians (e.g., midwives) for procedures typically performed by physicians in the US. And drugs are cheaper thanks to the government’s negotiating power. So between efficient administration, less waste in patient care, cheaper doctors, greater use of non-doctors, and lower drug costs, Denmark’s universal health care system has managed to be about 6% cheaper than the not-quite-universal system we have in the US.

There is a down side to the Denmark’s system, however. Lack of quick access to specialists appears to be a factor in a couple of bad stats: compared to other Europeans, Danes don’t live as long and have lower cancer survival rates after diagnosis. While the healthcare system isn’t responsible for the incidence of cancer (that, perhaps, is due to certain lifestyle factors: the Danes have high rates of drinking and smoking), delays in getting to specialists (and the hospitals where they work) results in later diagnoses and time is of the essence when treating cancer.

Overall, then, I’d say Denmark’s healthcare system is pretty good – not perfect. The US could certainly benefit from trying out bits of the Danish model. I’d start with looking at ways Denmark contains costs, since the feasibility of universal care in the US is partly a matter of affordability. Perhaps some states could experiment with replacing a litigated malpractice system with a state-run system, similar to how workers’ compensation works. The US should also do whatever it takes to increase the number of General Practitioners, while expanding the roles of both GPs and non-physicians in patient care. As it is now, the shortage of GPs means a lot of patients can’t see their doctors on a timely basis, which has lead to an increase in emergency room visits, even though more patients have medical insurances thanks to Obamacare. What is the use of universal care if you can’t get an appointment to see your doctor?

Denmark as a Model for the US

Politics and Economics

Bernie Sanders thinks we should be more like Denmark. Hillary Clinton doesn’t buy it. “We are not Denmark” she says, “…we are the United States of America.”

What’s so special about Denmark?

The many attractions of Denmark include a generous safety net that provides unemployed workers 90% of their old salary up to 2 years. Parents receive up to 52 weeks of leave per child and daycare is heavily subsidized. Overall, working-age families receive more than three times as much aid, as a share of G.D.P., as their U.S. counterparts. Danes enjoy the world’s shortest work week and have the right to 5 weeks of paid vacation a year. College students not only have free tuition but get a stipend of over $900 a month. Denmark’s chronic poverty rate is just .6%, while it’s 2.7% in the US. Per-capita income in Denmark is higher, and income inequality much lower, than in the US. Plus, the Danes are the third happiest in the world (after Switzerland and Iceland). What’s not to like?

For starters, all this Danish largesse is paid for by very high taxes. Denmark has one of the highest individual tax burdens in the world. And its tax system is much less progressive than what we have in the US: whereas the US top marginal income tax applies to income over 8.5 the average income, in Denmark the top rate (59%) applies to all income over 1.2 the average income. The lowest individual tax rate is 37%. Denmark’s Value Added Tax is another 25%. Then there are special fees and taxes, like the 180% tax on cars. In Denmark, all those government benefits aren’t really “free” – they’re funded by taxes, paid mostly by the middle class.

Coming next: exploration of the Denmark model, the Denmark reality, and how this all relates to the US.