reducing your carbon footprint? don't drink outside the box

As if wine needs another reason for us to love it, here's one more: Boxed wine is good for the environment.

This week's New York Times wine blog rekindled my love for all things boxed wine - it's cheaper, it stays fresh longer, and despite the reputation of Franzia and other similarly low-quality wines, there is actually a pretty good selection of high-quality wines that just happen to have bag-in-box packaging. There's a box of cheap sangria in my fridge right now, and it brings me great happiness - it may not be Moet et Chandon, but it's palatable both financially and gustatorily. As one blogger puts it, "Boxed wine may be short on charm, but it is long on practicality." Pretty much the only reason bottled-and-corked wine is so popular today is because of the perception that these wines are finer. Glass packaging may actually be bad for the product - glass allows light through which may degrade the wine, and the cork can seep into the liquid which can taint the flavor.

But my favorite pro-box argument is that boxed wines have a smaller carbon footprint that bottled wines. How exactly, do you ask? Through three main routes:

(1) Less gasoline emissions due to cheaper transportation. Boxed wines weigh less per liter of liquid than bottled wines (cardboard is lighter than glass). Also, greater quantities of boxed wine can fit in cargo areas due to their rectangular and easily-stackable shape, whereas bottled wine is fragile and oddly-shaped, making it difficult to ship. More wine for less gas means fewer carbon footprints!

(2) Cardboard and glass are both recyclable - but it is oftentimes more difficult to locate glass recycling facilities. Also, neighborhood recycling collectors sometimes won't pick up glass because it's too dangerous for the collectors. Cardboard, in most cases, is easier to deal with recycling-wise.

(3) When you open a bottle of wine, you have to finish it within about 48 hours. When you open a box, you've got at least a month. People are more likely to toss out day-old bottled wine due to spoilage - thus, boxed wine can reduces burden created by waste.

Let's not forget that boxes and bottles both contain wine - and while the product may not be identical in flavor, their ingredients are pretty similar. And the health-promoting effects of these ingredients are pretty well-publicized, when consumed in moderation. Because boxed wines are generally less expensive, this allows a greater number of people - of a greater range of income - to benefit.

Boxes do have their environmental drawbacks - the plastic bag inside the boxes is usually not recyclable, and more labor is needed to assemble these boxes (which corresponds with greater manufacturing emissions). But these are tradeoffs which, in the long run, may not outweigh the pro-box arguments.

So would it really be so outrageous to suggest that policymakers subsidize American wine manufacturers who box their wines? In a few years, America will probably be the biggest wine producer in the world, so it's important to think about how this global industry operates. We're trying to be a more environmentally responsible nation, and if there were incentives to try and change the perception of boxed wines, more wineries would box better-quality wines, quality sellers would keep more boxed wines in stock, and more consumers would switch to this packaging style. A decade or so ago nobody with class would even dream of drinking beer out of a can - but breweries knew it was an easier format to ship, and aluminum was easier to recycle. Eventually people came to allow cans to be an acceptable packaging (even New Belgium's Fat Tire is now sold in cans!). Maybe the boxed wine revolution needs a little subsidizing - or just a subtle policy push - in order to get rolling.

Oh, and technically, the most environmentally prudent way to consume wine would be to have your own glass jug and fill it up yourself at local wineries. No cross-country transportation, reusable container, and support of the local business economy. While it's a great idea, not everyone lives near a winery, and I'm not even positive if the owners allow this kind of transaction. I've personally filled up a growler at Lazlo's, a local microbrewery back in Nebraska. Maybe I'll try my luck with the jug at Bishop's down the road.) But it's how many families get their wine in France, and maybe U.S. wineries can accommodate (or at least publicize that they accommodate!) this technique soon.

the ugly side of snow days

The issue: School closings and snow days

The vocab: Snow days are usually perceived as fun and as a respite from the daily school grind - but for some kids who rely on the school's resources, snow days aren't so quaint

The Northeast has been battling record snowfall for the past two weeks - hundreds of flights were cancelled, car accidents abounded, and almost every school from Virginia to Maine was closed for days. (Well, except for Yale, which hasn't declared a snow day in more than 30 years.)

One thing a lot of us don't think about is the public health trade-off schools make when declaring snow days. School is usually cancelled in the name of student and staff safety - that is, fewer automobile/bus accidents and less exposure to dangerously low temperatures. But there are health risks associated with not being in school, too.

Besides the inconvenience to parents who have to find a last-second babysitter, and besides the inconvenience to teachers whose lesson plans are disrupted, there are negative effects that students must face if school is cancelled. As discussed in stories from both MSNBC and the Newark Advocate, many elementary, middle and high school students rely on free breakfast and free/reduced-price lunch - and their family may not be prepared to provide these meals when their children are unexpectedly home for a few extra meals.

Here in New Haven, most schools were closed at least two days these past couple of weeks. And most of the schools in town have about 60% of their students on the free and reduced-price lunch program. While schools often have a bad rep for the quality of their cafeteria lunch menus, this may actually be the most nutritious meal some kids get that day. In order for a school to participate in the program and receive subsidies from the Federal government, cafeteria food must meet certain nutritional guidelines - with limits on calories and fat, and requirements for vitamin content.

So what can families do when they unexpectedly have another mouth (or so) to feed? In Philadelphia and D.C., where schools were apparently only open one day all of last week, food pantries were either (1) closed due to the inclement weather or (2) running low on food because of the unusually high demand.

Some school administrators in Evansville, Indiana - a midwest town that's no stranger to frequent winter school closings - started a pilot program last week, where kids who were brave enough to trek to one of two local schools could still get a free lunch. (It's unclear whether they had to be eligible for the federal free/reduced-price lunch program, or if just anyone under 18 could roll in.) If a State of Emergency is declared in the city this back-up program would close as well. But when school is closed for several days straight, chances are the city won't be in a snow emergency the entire time - and due to the efforts of this school district kids will have at greater access to nutritious meals in otherwise tough times. And it does put kids at risk - if the weather's bad enough to close schools, it's probably at least mildly perilous to get to school to take advantage of the program. But at least it's a resource that families can use if food options are running low.

Snow days should be fun - it shouldn't be a stressful time where parents have to worry if they're going to be able to feed their kids. The government already has a free/reduced-price lunch program for eligible kids to use during the summer - they should maybe expand this they way schools in Evansville did, so on unexpected closures kids can have access to nutritious food ... and then go play in the snow like kids should be doing!

[And now for your non-public health side note ... while googling Connecticut cafeteria policy, I came across a story about a 55-year-old cafeteria worker in Danbury who got put in jail after getting in a food fight with a fifth-grader. God Bless Connecticut.]

olympians' most dreaded foes: cold and flu

The issue: Olympians' health while competing in Vancouver this month.
The vocab: Banned performance-enhancing substances ... in the International Olympics Committee's eyes, cold and flu medications are equivalent to doping.

The Olympics are always wrought with controversy over alegations of performance-enhancing substance abuse. While the summer games tend to have higher rates of offenders, the winter games aren't immune from illegal performance enhancement. In Turin's 2006 games only one athlete was busted for using a banned substance. But back in 2002 when Salt Lake City was host, seven competitors were caught - including four medalists, all of whom had to forfeit their prizes.

The International Olympic Committee surely prides itself on rigorously ensuring fair competition through frequent testing and harsh consequences.

But has anyone thought about the negative side effects of such stringent substance bans on the athletes in Vancouver this month?



The New York Times came out with a story today about Olympians' battles with their harshest competitors - The Common Cold and The Flu. Athletes have the triple whammy that increases their susceptibility to illness:

1. Being around millions of people, and being in close quarters with fellow athletes in Olympic Village, increases the chance of transmission.
   
2. Intense physical activity suppresses the immune system, decreasing the body's ability to fight off cold and flu.


3. Athletes aren't allowed to take many of the everday cold and flu meds because of the IOC's strict rules against banned substances. Some cold and flu remedies contain stimulants just like the ones in banned amphetamines - in smaller doses, yes, but still detectable via routine drug testing.

Dr. P. Gunnar Brolinson is a team physician at the Vancouver games, and is the author of a 2007 article published in Clinics in Sports Medicine about the immune-suppressing effects of rigorous exercise. In the NYT article, Brolinson says, "The biggest reason for poor performance at an internation, multisport games is a respiratory infection."

So what we have here is a public health tradeoff - do the risks of acquiring a cold or a flu outweigh the risks of allowing these medications?

Until drug testing becomes sophisticated enough to distinguish between a small dose of cold/flu medicine and a true banned substance, Olympians will have to deal with the regulations by becoming more proactive in preventing illness. Vancouver is literally giving away flu vaccines. Over 40% of the city's residents have been vaccinated, and the Canadian Olympians have set a stellar example for their colleagues, with more than 80% of the Canadian team receiving vaccines throughout the flu season. And I suppose you could go one step further like U.S. cross-country skier James Southam, who admitted to carrying a hospital mask in his carry-on bags just in case one of his co-riders was looking under the weather. But recall the reports from the beginning of the swine flu epidemic: there's doubt that hospital masks protect casual wearers all that much. (Plus it makes you look like a massive dork.)

And what if, despite preventive efforts, a cold or flu begins to emerge?

Old school remedies are the answer, in this case. Lozenges, ibuprofen and antibiotics (if necessary) are perfectly fine. Some Olympians are actually spokesmen for anti-cold remedies - U.S. speedskater (and much hunkier without his ridiculous soul patch) Apolo Ohno has an ad for DayQuil/NyQuil. Both of which are allowed by the IOC.



While it may be tricky for athletes to stay cold- and flu-free during the Vancouver games, the winner of the public health tradeoff is clear: The IOC would much rather risk athletes getting sick than risk allowing athletes an unfair competitive advantage.



[An aside... Chuck Klosterman wrote a fairly famed essay about the Olympics back in 2004 for Esquire magazine. Not public health related, sadly. But as always with this guy, it's a fascinatingly convoluded and hilarious read.]

avatar & james cameron's (inadvertent?) health policy commentary

The issue: James Cameron's interpretation of the future of healthcare

The vocab: Health insurance coverage for veterans

So I finally got around to seeing Avatar. And yes, it was visually stunning and a technical masterpiece and so on. I'll let the reviewers and The Academy do the fawning - for there is health policy subtext to be analyzed.

The protagonist is Jake Sully, a former Marine who was paralyzed from the waist down (which is presumably a war injury). Jake had agreed to travel to the distant planet Pandora and gather information on Pandora's indigenous people for the U.S. military unit stationed there - in return for his intel, the unit's Colonel promised to pay for spinal surgery that would enable Jake to use his legs again. Being the good public health student (read: dork) that I am, I turned to my friend sitting next to me and exclaimed:

"So James Cameron is saying that in 150 years, even though the technology had been invented to reverse paralysis, an injured war vet doesn't get enough health insurance coverage for spinal surgery???"

OK, yeah, the point of the movie is to blow you away with the visuals and submerge you in the blatant environmental commentary - but I got preoccupied for a while with this insurance coverage bit. But then I realized, I don't actually know what the current state of health coverage is for those on active duty and veterans.

When someone is on active duty, they receive insurance through the Military Health System. Those who are honorably discharged are then shuffled over to Veteran's Affairs insurance (or to their employer's or private insurance, if they opt). According to the Veteran's Affairs benefits site, there are two types of benefits: ones for service-connected disabilities (i.e., those that occurred during active duty), and ones for nonservice-connected disabilities. Sully was a victim of the former. He'd definitely be getting some monthly compensation, somewhere between $123 and $2,673, depending on what his "level of disability" was assessed to be. But I can't figure out from the VA's website if his insurance would cover expensive spinal surgery several years after the injury was suffered.

I suppose that's an interesting weakness to point out in and of itself - it's pretty impossible for the average person to easily scroll through veterans' benefits package and actually understand what to expect. For example, the site states that veterans receive a monthly stipend based on percent disability, but it doesn't explain (or link to a site that explains) how percent disability is determined. Part of the Senate's proposed health bill calls for the creation of an Internet site that clearly lists healthcare options and comparisons of benefits packages. Maybe the VA should set an example.

Speaking of health reform, let's look into how the recent healthcare overhaul talks could affect veterans - are we dooming our nation's future vets to unaffordable healthcare services and inadequate coverage for vets with service-related disability? Are we setting the stage for Jake Sully's predicament?

Probably not. First of all, I'd like to think that if doctors in the future are able to reverse paralysis, the VA would be extremely eager to help vets with war injuries (and I'd bet that taxpayers would gladly help share the costs). And secondly, according to The White House Blog, Obama's 2010 budget includes "the largest single-year increase in funding for the Department of Veterans Affairs in three decades, and significantly expands coverage, extending care to 500,000 more veterans who were previously excluded."

So do I buy James Cameron's depiction of a future where a disabled war veteran can't get paralysis-reversing surgery?? Nah. I don't think Congress or taxpayers would stand for it. And I don't think the VA will ever shrink the benefits package - it can really only grow. While the movie is grounded in fantasy and science fiction and imagination, it's simply not believable that Jake Sully wouldn't have health coverage in a non-Cameronsian (read: possible) future.

concussion commotion

The Issue: Concussion policy in all levels of football

The vocab: "Concussion" is a pretty common occurrence and a pretty common word - but let's not forget that it's still a brain injury.

Concussions are pretty common, especially for athletes - there are 3.8 million sports-related concussions every year (and probably millions more that are unreported). Because of its relative ubiquitousness, the public hasn't appreciated the long-term implications of the event. Well, until recently. The official medical term is a "mild traumatic brain injury," a terminology which I think better characterizes the severity of the injury. (And for those interested in the medical background, the fine people at Wikipedia, as always, have a great review.)

Concussions are especially incident in my beloved sport of football. Florida's QB Tim Tebow suffered one in a regular season game against Kentucky that kept him out of practice for a couple weeks, and Cal's phenomenal RB Jahvid Best suffered a reeeeally chilling one that put him out for the rest of the season. Whoever you're cheering for (and trust me, I'm no fan of Tebow), no one wants to see a player hurt. Including Congress.

Congress is looking at legislation that would protect athletes at all levels from exacerbating excessive complications due to concussion. The House Judiciary Committee held a forum today in Houston to talk about how high school football coaches are currently dealing with players who have had concussions. Dr. Bennet Omalu, a forensic neuropathologist and the foremost researcher in football-related head injuries, testified at the forum. He strongly recommends that players under the age of 18 should be required to sit out for three months after sustaining a concussion.

Most people are in favor of the proposed changes in policy - as Dr. Omalu outlines in his book Play Hard, Die Young, because football

players are subjected to repeated head injuries, they are much more likely to suffer from dementia and depression later in life. There are obviously immediate dangers, too. Matt Blea, a high school football player from San Jose, was in a coma for 17 days after getting knocked out in a game on Thanksgiving day - it was a very scary situation for everyone involved (Blea is reportedly recovering tremendously, but will probably never play football again ... but hey, at least he got to meet Heisman runner-up Toby Gerhart [In the pic, Blea is on the left and Gerhart is on the right]), and Californians have since rallied together to enforce more regulations that would protect high schoolers from head injuries.

Interestingly, and I suppose as we have all come to expect, not everyone is in support of Congress stepping in. Two Republican congressmen from Texas, Ted Poe and Lamar S. Smith, are critical of the proposed legislation. According to the New York Times, Poe is quoted as saying,

I mean, if Congress gets involved, it would seem to me it would be the end of football as we know it. We would all be playing touch football on these fields.

The man's got a point. I mean, people know what they're getting into when they strap on those helmets and allow 300-lb linemen knock them over. (I can just hear Colorado coach Dan Hawkins gearing up to reprise his famous, exasperated one-liner: "It's division one football!!") And I'm sure Poe wants coaches to be responsible when making decisions that affect players' health. It's just a matter of whether or not Congress should intervene.

The NFL has set a really stellar example for NCAA and high school football policy. They NFL conducted its own study about the long-term effects of repeated head injury (and while it suggested that players are at a higher risk for dementia, the results were statistically inconclusive ... for now), and they already held forums with the House Judiciary Committee about how they'd like to change head injury policy. The NFL's going to (1) institute stricter league-wide return-to-play guidelines and (2) require every team to hire an independent neurologist, who must be consulted before the player can even come to practice.

[A quick side note that's more about research than policy... Current and former players are getting pretty gung-ho about helping brain injury researchers, all for the benefit of future generations of players. A dozen or so NFLers have volunteered to donate their brains to the Boston University School of Medicine after their death. Kind of icky, but kind of cool.]

Because the NFL is a centralized and unified league (the same is basically true for the NCAA, it's just much larger), they can make these sorts of guidelines, fund the provisions, and actually monitor their enforcement. But there isn't a similar nationwide cohesive entity for high school and youth sports - and perhaps it's appropriate for Congress to enforce federal legislation to protect players. And in an effort to ease the financial burden for schools (and players' parents), the federal government proposed an Act that would give $10 million to high schools and middle schools so that coaches could accurately assess concussions.

Concussions have deserved attention for a long time - and there is basically a consensus amongst players and coaches and politicians (and anyone else you possibly think of) that concussions need to be dealt with in a more consistent and medically-sound manner - especially in younger players. [And, by the way, I'm irrationally excited to see BU's analysis of the NFL brain autopsies, even though it'll be a couple decades. Brain research is cool, but brain research on football players is waaay off the cool charts.]