Worldwide, the numbers of children who die before their fifth birthdays is on the decline. Still, millions of children are being lost to diseases and complications that are completely preventable.
In a study published earlier this week in the Lancet, researchers examined the reasons behind the 6.3 million deaths among children younger than 5 in 2013 — a number that’s significantly less than the 9.9 million such deaths that occurred worldwide in 2000. Nearly 2 million of the 2013 child deaths were due to complications from preterm birth and pneumonia, both of which were leading causes in 2000 as well. However, complications due to childbirth is now the third most common cause of child death, displacing diarrhea, which still a leading cause of child mortality, killing more children every day than AIDS, malaria and measles combined. Since 2000, child deaths due to measles, tetanus, HIV and diarrhea fell the fastest, with about half of the 3.6 million fewer child deaths occurring between 2000–2013 due to reductions in pneumonia, diarrhea and measles fatalities.
“We have seen huge successes, but there is still a long way to go,” said study author Robert Black, a professor in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health, in a news release. “Millions of children are still dying of preventable causes at a time when we have the means to deliver cost-effective interventions. And if we don’t continue to devote research, resources and attention to the issue of child survival, we are going to lose the battle.”
To calculate the child mortality rates, researchers examined vital statistics records and oral autopsy data and used computer modeling to produce child death estimates for the World Health Organization’s 194 member states. The study found that sub-Saharan Africa is home to the largest burden of child mortality. About half of the 6.3 million child deaths in 2013 happened in sub-Saharan Africa, which is also predicted to be home to 60 percent of child deaths in 2030 if current trends stay the same. Overall, the three leading causes of child death in 2013 were preterm birth complications, pneumonia and intrapartum-related complications (emergencies during childbirth, such as birth asphyxia).
Nearly 52 percent of younger-than-5 deaths were due to infectious causes, with pneumonia, diarrhea and malaria at the top, the study found. The most common causes of neonatal death were preterm birth complications, intrapartum-related complications and neonatal sepsis or meningitis or other infections. The five countries with the highest numbers of children dying before age 5 were India, Nigeria, Pakistan, Democratic Republic of Congo and China. On a more positive note, southern Asia and sub-Saharan Africa were home to the largest reductions in deaths among children younger than 5.
The study notes that the worldwide Millennium Development Goal of reducing the death rate among children younger than 5 by two-thirds between 1990 and 2015 remains unmet and if trends stay the same, 4.4 million children will still die from often-preventable causes in 2030. However, if all countries were able to reduce their younger-than-5 mortality rate to 25 deaths per 1,000 live births, the estimated 2030 death rate could be cut nearly in half. The study also noted a “major transition” for child survival highlighted by the fact that preterm birth complications are now the leading cause of younger-than-5 deaths globally. Study authors Black, Li Liu, Shefali Oza, Daniel Hogan, Jamie Perin, Igor Rudan, Joy Lawn, Simon Cousens and Colin Mathers write:
A well-recognized shift is apparent in the timing of child deaths closer and closer to the time of birth. This shift is now happening all over the world, with 44% of child deaths in the neonatal period. Africa is the region with the lowest proportion of death in the neonatal period, partly because of specific postnatal and child causes, notably malaria and HIV. This shift is indicative of progress in reductions of infection deaths for children, and slow progress for neonatal mortality reduction and particularly preterm birth, for which prevalence is rising in many countries; even simple care is often scarce.
Scaling up health care services for newborns and to prevent preterm birth seem to be significant components of reducing global child death rates and though that’s a complex and multifaceted endeavor, the study notes that there are easy, low-cost places to begin. For example, a method known as “kangaroo mother’s care,” in which the newborn is placed on the mother’s chest to improve breathing and stabilize body temperature, costs nothing to implement and yet isn’t as widely used as it should be. Moving toward the future, the authors write that “disease-specific interventions are only part of the solution” — they also call for socioeconomic interventions, such as widening access to family planning services, which improves maternal health, and creating more opportunities for women’s education and socioeconomic development.
“Going forward, it’s going to be harder and harder to make the kind of headway we have seen in child deaths,” said lead study author Liu, an assistant professor in the departments of Population, Family and Reproductive Health, and International Health at the Bloomberg School of Public Health. “We have gone after some low-hanging fruit, but even in those areas there is still so much room for improvement. More, not fewer, resources are needed.”
To read the full child mortality study, visit the Lancet.
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.
Last month, when California Governor Jerry Brown signed the Health Workplaces, Healthy Families Act of 2014 into law, he made his state the second in the nation with a law mandating paid sick days. In 2011, Connecticut became the first state to require that employers let workers earn and use paid sick time – although, it only applies to businesses with 50 or more employees. California’s new law, which takes effect July 1, 2015, exempts some classes of workers but otherwise applies to all employers with at least one employee.
In November, Massachusetts voters will decide whether to add their state to the list of those with paid-sick-days requirements (Kim wrote about this in August). The list of cities with laws requiring paid sick days has been growing steadily, and currently includes San Francisco, CA; Washington, DC; Seattle, WA; Portland, OR; New York City; Jersey City, NJ; Newark, NJ; Eugene, OR; San Diego, CA; and Passiac, NJ.
Paid sick days are important for eliminating the difficult choice that many workers face between staying home to recover from an illness (or care for a sick child) and dragging themselves into work because they need the money. When workers can take paid sick time, they’re less likely to spread flu or other diseases to their co-workers. The current laws generally allow workers to earn and use between three and five paid sick days each year.
A few days off work might be sufficient to get over the worst of a cold or flu, but it’s not enough for workers to address their own serious health conditions, care for a family member with a serious health issue, or bond with a new baby or a new adopted or foster child. In such situations, workers need paid medical or family leave, but here in the US, many don’t have it. Women are more likely to be primary caregivers, so they bear more of the burden from insufficient paid leave. The existing federal law, the Family and Medical Leave Act, only allows for unpaid leave, and only covers about 60% of US workers. The FAMILY Act has been introduced to allow for paid family leave for all employees nationwide, but its prospects seem dim at this point.
On paid family leave, too, a few states have led the way. California, New Jersey, and Rhode Island have all established social insurance systems that use payroll-tax funds to replace a portion of workers’ salaries for several weeks when they miss work to care for new children or seriously ill family members.
Last week, the US Department of Labor’s Women’s Bureau and Employment and Training Administration awarded grants to three states and DC to fund studies on paid leave. The DOL news release explains:
- The District of Columbia Department of Employment Services will receive $96,281 to produce an economic impact analysis, financing and benefit models, and a cost-benefit study to assess the feasibility of enacting a paid family leave program.
- The Massachusetts Department of Labor Standards will receive $117,651 to conduct research and develop a microsimulation model that will help the state estimate eligibility, take-up and benefit costs of a variety of proposed paid family and medical leave programs.
- The Montana Department of Labor and Industry will receive $124,651 to research the feasibility and economic impact of creating a state paid family leave program — including providing financing, eligibility and benefit recommendations — and to conduct public opinion research for communications and implementation purposes.
- The Rhode Island Department of Labor and Training will receive $161,417 to determine the effectiveness of the Rhode Island Temporary Caregiver Insurance Program and its benefits for Rhode Islanders, as well as the public’s awareness of the program.
It’s fitting that Rhode Island is one of the grant recipients, given that this state launched its family-leave insurance program earlier this year. And days after the federal grants were announced, the DC government began offering up to eight weeks of paid family leave to its employees.
Momentum is building for policies that allow workers to care for their own health and that of their family members without risking financial ruin.
Read the interview.
Not an “accident”: William Jeffrey Belk, 29, suffers fatal work-related injuries at Boise Cascade plywood plant in North Carolina
William Jeffrey Belk, 29, suffered fatal traumatic injuries on Friday, September 26 while working at the Boise Cascade Wood Products plant in Moncure, NC. News reports provide some initial information on the worker’s death:
- “The Chatham County Sheriff’s Office says a worker at a wood products company died when a piece of machinery fell on him.”
- John Sahlberg, senior vice president of Human Resources at Boise Cascade, told The Sanford Herald: “The equipment had a C-clamp, and somehow or another, the C-clamp was up and came down on him. We don’t have details as to what he was doing or why the C-clamp was up.”
The Wood Working Network reports:
“The specialty plywood mill, which Boise Cascade purchased in a year ago, produces both hardwood and softwood panels. Boise Cascade acquired the Moncure plywood mill, along with Chester Wood Products, from Wood Resources LLC in September 2013 for $102 million.”
William Jeffrey Belk is survived by his wife, three sons, and three daughters.
OSHA’s on-line record of inspections does not show any inspections of the workplace when it was Moncure Plywood. Since January 2010, a number of Boise Cascade operations have been inspected by State OSHA agencies in Washington, Oregon, Tennessee and South Carolina. Two of the inspections resulted in the company paying a penalty for serious violations.
Each year, dozens of workers in North Carolina are fatally injured on-the-job. The Bureau of Labor Statistics reports 104 work-related fatal injuries in North Carolina during 2013 (preliminary data, most recent available.) Nationwide, at least 4,405 workers suffered fatal traumatic injuries in 2013.
The AFL-CIO’s annual Death on the Job report notes:
- North Carolina OSHA (NC-OSHA) has 104 inspectors in the state to cover more than 215,000 workplaces.
- The average penalty for a serious OSHA violation in North Carolina is $996.
NC-OSHA has until mid-March 2015 to issue any citations and penalties related to the incident that stole William Jeffrey Belk’s life. It’s likely they’ll determine that Belk’s death was preventable. It was no “accident.”
The villagers of Setulang in Indonesian Borneo have enlisted a new ally in their fight against the illegal clearing of their forests for oil palm plantations: aerial drones. The indigenous Dayaks manage the surrounding forest conservation area, and they are hoping the drones can help them ward off illegal oil palm operations and protect their land. “Dayaks and Drones,” a video produced by Handcrafted Films, chronicles how the villagers teamed up with an Indonesian nonprofit to learn how to program and operate drones. Equipped with GPS technology, the small drones photograph the forest and monitor the area for illegal activities.
Watch the video.
Compliments to the chef: Partnerships between school food staff, professional chefs lead to healthier eating
Building excitement around school meals with the help of guest chefs and fresh recipes could be a significant boon for school lunch programs as well as student eating habits, a new study found.
Recently published in the journal Appetite, the study examined the impact of Chefs Move to Schools, an initiative of First Lady Michelle Obama’s Let’s Move campaign. With an overriding goal of encouraging schoolchildren to make healthier meal choices, Chefs Move to Schools pairs volunteer professional chefs with schools to offer cooking education to kids as well as culinary advice to school food services staff. Researchers wanted to know if bringing guest chefs into schools would positively impact school lunch program participation and whether the newly created meal offerings could increase student consumption of fruits and vegetables.
Participation in the National School Lunch Program has come under some scrutiny lately as schools transition to meet new federal nutrition standards, and guest chefs could be one way to rally student enthusiasm and inspire school meals that are healthier, yet appealing to young people. (In 2012, the U.S. Department of Agriculture in accordance with the Healthy, Hunger-Free Kids Act of 2010 issued new nutrition standards for school lunch meals. More on those changes are here.) To study the impact of the chef initiative, researchers helped organize a pilot event at an upstate New York high school and with the support of the school’s food service staff, welcomed a volunteer chef who specialized in French cuisine to participate.
Before the main event, the volunteer chef visited the school to meet with food service staff and learn about the foods available to the school cafeteria, eventually deciding to develop recipes for foods already popular with students. The guest chef, whose recipes stayed within the standards of the National School Lunch Program, made three pizzas — meat taco pizza, bean taco pizza and garlic spinach pizza — as well as a ranch burger. (The pizza was made with whole-wheat crust and low-fat mozzarella cheese, while the hamburger was made with a whole-wheat bun dusted with cool ranch seasoning.) In addition to the guest chef’s offerings, the school chef prepared a meat lover’s pizza, a mozzarella burger and pre-packaged salad with fresh greens, walnuts and raspberry vinaigrette dressing. A day before the new foods were officially rolled out, an after-school tasting was held where students could meet the volunteer chef and talk about her food creations. With excitement buzzing the next day, students filed into the cafeteria to make their meal choices.
In examining the resulting sales data and plate waste, researchers discovered that the effort did make a positive difference. They found that after the new meal items were introduced, 9 percent more students bought National School Lunch Program-compliant meals. And while plate waste showed that students ate about the same amount of their entrée as they had previously, they also ate 16 percent more of the selected vegetable sides, most notably the newly offered pre-packaged salad. Researchers speculated that the uptick in veggie consumption might have been due to the appetizing pairing of pizza and salad.
Study co-author Andrew Hanks, an assistant professor in the Department of Human Sciences at Ohio State University and an affiliated researcher with the university’s Food Innovation Center, said he and fellow researchers expected to see higher school meal participation, but the veggie part was a happy surprise.
“You market the foods and encourage kids to come and buy lunch with a tasting event, so you expect the excitement to increase and to see the increase in purchases of school lunch,” Hanks told me. “But the increase in vegetable consumption was little bit of a surprise. We’re excited to see that.”
Hanks said that while the study doesn’t tease out whether the positive impact was due to the excitement of hosting a guest chef or the actual food offerings, the whole point of the study is to examine the Chefs Move to Schools (CMTS) initiative as a package. In other words, CMTS is designed to foster long-term partnerships between professional chefs and local schools, and so the study examined the value of the initiative as a whole. Still, CMTS is not without its challenges. Study authors Hanks, David Just and Brian Wansink write:
Despite the initial fanfare at the onset of the CMTS program, tight school budgets and the narrow nutritional requirements of the National School Lunch Program, relative to those faced by professional chefs, have caused many to question the ability of professional chefs to contribute to school foods. In fact, some school food service professionals have been very vocal in their opposition. Professional chefs tend to operate with complete freedom when selecting ingredients and tend to prepare dishes that are significantly more expensive than the typical school lunch. Additionally, there are questions as to whether students would value higher quality creations over the traditional lunch fare.
Hanks told me that some resistance is natural when an outside chef comes into a school cafeteria that’s home to long-time employees. That’s why relationship building is important. In the case of the pilot event in upstate New York, the guest chef made an effort to “live in the school chef’s shoes,” Hanks said. The guest chef featured in the study was interested in learning about school foods, in learning from the school chef and she made an effort to develop her recipes using foods that were easily accessible to the school cafeteria.
Overall, the study concluded that CMTS has the potential to persuade more kids to eat healthier foods as well as increase school food service revenue, which could help offset any expenses related to new recipes and ingredients. Hanks said that while the study was a fairly small one, the results could be useful to schools in every community.
“One of the benefits of the (CMTS) program is that there’s no set rulebook that a school or chef has to play by, so each school can tailor its own program to its needs,” he told me. “Our hope is that (school) cafeterias can pick a couple elements and apply them in their own settings to enhance the experience for school lunch staff and students as well as have it be an educational opportunity for the outside chef, too.”
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.
There’s been a lot going on this past week so it’s likely that National Farm Safety Week, announced by Presidential Proclamation on September 19th may have escaped notice of those not working in agriculture. “America,” said President Obama in the proclamation, “depends on our farmers and ranchers to clothe our families, feed our people, and fuel our cars and trucks.” And he continued:
“While our farmers and ranchers are the best in the world, agriculture remains one of our country’s most hazardous industries. Producers and their families are exposed to numerous safety and health dangers — from vehicular fatalities and heat-related illnesses to injuries from falls and sicknesses from exposure to pesticides and chemicals. With preparation and proper training, these risks can be limited and lives can be saved. That is why my Administration continues to pursue innovative and comprehensive ways to lessen these hazards. We have invested in programs that improve youth farm safety, and last year, we announced plans to support the development of a national safety training curriculum for young agricultural workers.”
What caught my attention was the mention of safety training for young agricultural workers. In April 2012, much to the surprise – and distress – of those in the public health and workers’ rights community, the Obama administration withdrew its proposed regulation to increase protections for children aged 16 and under working on farms. “The decision to withdraw this rule — including provisions to define the ‘parental exemption,’” wrote the Department of Labor (DOL) in its April 2012 press release, “was made in response to thousands of comments expressing concerns about the effect of the proposed rules on small family-owned farms.”
“To be clear, this regulation will not be pursued for the duration of the Obama administration.”
The proposed rule – which the Obama administration promised not to pursue – recommended that children aged 15 and younger who are being paid to do farm work be barred from some of the most hazardous types of agricultural work, including work involving grain silos, manure pits, motor vehicles, livestock and pesticides. “Children employed in agriculture are some of the most vulnerable workers in America,” said then Labor Secretary Hilda L. Solis, announcing the proposed rule on August 31, 2011. “Ensuring their welfare is a priority of the department, and this proposal is another element of our comprehensive approach.”
There are some state variations, but currently under federal law, anyone aged 16 and older can perform any farm job, including agricultural work the Department of Labor considers hazardous and can do so at any time, including during school hours. Children of 14 and older can be employed outside of school hours for any agricultural work except those jobs DOL considers hazardous, while children 12 and older can work outside of school hours if they have written parental consent and 13 year olds can work without written permission on farms where their parents or guardians also work. Children 12 and younger can be legally employed outside school hours with parental consent on farms exempt from federal minimum wage provisions – that is, small farms. However, children of any age can work if employed by a parent or guardian on farms owned or operated by those adults. The hazardous agricultural jobs prohibitions do not apply to children working on farms owned or operated by their parents. The proposed rule would have strengthened hazardous agricultural work provisions for 14 and 15 year olds and created new Hazardous Occupation Orders for those under 18.
When DOL abruptly withdrew the proposed rule in April 2012 it announced that: “Instead, the Departments of Labor and Agriculture will work with rural stakeholders — such as the American Farm Bureau Federation, the National Farmers Union, the Future Farmers of America, and 4-H — to develop an educational program to reduce accidents to young workers and promote safer agricultural working practices.” So I set out to find out how this announced program is progressing.
No safety training required for children and teens working in agriculture
First, it helps to know that there are currently no nationwide requirements for safety training or education for young people working in agriculture. Any training is provided entirely voluntarily. “Under the law there are no federal mandatory requirements for training” young people who are hired to work in agriculture, explained American Farm Bureau Director of Congressional Relations, Kristi Boswell. “There is no required training or education at this point,” said Aida Balsano, a National Program Leader with the US Department of Agriculture’s (USDA) National Institute of Food and Agriculture. But there are, she said, “lots of resources available.”
What I learned from the American Farm Bureau, National Farmers Union and USDA is that following the Obama Administration’s withdrawal of its proposed rule on children working in agriculture, these and other stakeholders began working through the Safety for Youth in Agriculture program (SAY) to identify existing safety training and other educations materials that could become part of a national curriculum. In September 2013, USDA announced award of a $600,000 grant to Pennsylvania State University to “develop a national training curriculum that lessens agricultural hazards to young workers.”
When ready, “Curriculum materials will be placed on the eXtension website in the new Ag Safety and Health Community of Practice to be used in both formal and non-formal settings,” wrote USDA. Also on the agenda is “a national outreach strategy to promote use of the curriculum” and a clearinghouse for “national youth farm safety and education curriculum, state certification requirements and testing.” The first phase of the project is expected to be completed this fall. The draft curriculum materials will be presented at a National Youth Safety Symposium taking place in Louisville, Kentucky on October 27 and 28, where additional input will be gathered from program stakeholders.
At the same time, explained Balsano, project collaborators CareerSafe and Ohio State University are working to develop a 10-hour course that will meet Occupational Safety and Health Administration (OSHA) approval and be applicable to agricultural workplaces. “By late August or early September of 2015 we anticipate having a final rubric for evaluating programs; existing identified training programs evaluated; and an agreed upon training for teachers and credentialing for youth from USDA and DOL,” wrote Balsano in a follow-up email. (CareerSafe is a private company owned by K2Share. No staff is listed by name on the CareerSafe website. Only contact is via email or call centers.) “The ultimate goal is to have youth pass a program that is recognized by OSHA and USDA. The educator would be able to provide youth who participate and pass their training with a certification card of completion which will have the USDA and DOL (OSHA) logos,” wrote Balsano.
Children in agriculture: 38 injuries per day – 115 deaths per year
Meanwhile, the National Institute for Occupational Safety and Health (NIOSH) estimates that 955,000 youth under age 20 lived on farms in 2012. Just under 50% of these young people were reported to be performing farm work. In addition to the 472,000 children living on farms doing farm work, an additional 259,000 youth were hired to work on US farms in 2012 bringing the total estimated number of young people working on farms to approximately 731,000.
NIOSH estimates that slightly more than 100 youth die annually from farm related injuries while more than 15,000 sustain farm-related injuries. According to NIOSH, leading causes of these fatal injuries involved machinery – including tractors, motor vehicles – including ATVs and drowning. While non-fatal injury rates have declined significantly since 1998, the National Children’s Center for Agricultural Health and Safety estimates that they are increasing among children under age 10. The Center also estimates that on average, 38 children per day suffer farm-related injuries.
This is the context in which the Obama Administration withdrew a proposed rule that would have strengthened safety requirements for young people and children working in agriculture – and in which there are currently no national safety training requirements.
Elizabeth Grossman is the author of Chasing Molecules: Poisonous Products, Human Health, and the Promise of Green Chemistry, High Tech Trash: Digital Devices, Hidden Toxics, and Human Health, and other books. Her work has appeared in a variety of publications including Scientific American, Yale e360, Environmental Health Perspectives, Mother Jones, Ensia, The Washington Post, Salon and The Nation.
A recent study has uncovered another possible risk factor for the development of type 2 diabetes: working long hours in low-paying jobs.
In a study published this week in the Lancet Diabetes & Endocrinology, researchers found that people who work more than 55 hours per week performing manual work or other low socioeconomic status jobs face a 30 percent greater risk of developing type 2 diabetes when compared to those working between 35 and 40 hours per week. The association remained even after researchers accounted for risk factors such as smoking, physical activity levels, age, sex and obesity as well as after they excluded shift work, which has already been shown to increase type 2 diabetes risk. The study is the largest so far to examine the link between long working hours and type 2 diabetes.
To conduct the study, researchers examined data from 23 studies involving more than 222,000 men and women in the U.S., Europe, Japan and Australia who were followed for an average of more than seven years. While on the surface, researchers found a similar type 2 diabetes risk among those who worked more than 55 hours per week and those working a more standard 35-40 hour week, more in-depth analysis revealed that workers in low socioeconomic jobs did, indeed, face a significantly higher risk. In other words, the association between long work hours and higher type 2 diabetes risk was only apparent among low-income groups. In a related commentary published in the same journal issue, authors Orfeu Buxton, a lecturer at Harvard Medical School, and Cassandra Okechukwu, an assistant professor with the Harvard School of Public Health, write:
(Study lead author Mika) Kivimaki and colleagues’ finding of an association only in the low socioeconomic status group suggests a possible role of sleep as a mediator; both inadequate sleep quality and quantity are strongly predictive of incident type 2 diabetes. A recent study showed that the association between short sleep duration and diabetes can be partly attenuated by inclusion of socioeconomic status. Working more consistent and less disruptive hours might explain the lack of associations for the individuals in the high socioeconomic status group. A related idea is the role of social jet lag — long working hours and short sleep during the weekdays combined with delayed sleep times on the weekend — that disrupts the circadian timing system and adversely affects metabolism. Laboratory studies have identified mechanisms by which disruption of the circadian system increases the risk of diabetes. Night work, a cause of circadian disruption, is also associated with higher risks of type 2 diabetes.
The study’s authors discussed three possible ways in which working longer hours could manifest into such a significant health risk for low-income workers. The first is that long work hours among low-income workers may be a marker of personal hardships and reflect other confounding variables, while workers with a high socioeconomic status do not experience such hardships and so working longer hours is not hazardous. The second hypothesis is that working longer hours may leave low-income workers with little time to engage in health-protective behaviors, such as getting enough sleep, exercising and socializing. The third possibility is that working longer hours is simply dangerous to a person’s health, but the authors write that “the fact that we do not see (the same health risks among workers with high socioeconomic status) suggests that the association is driven by confounding or indirect effects on other risk factors.”
Still, the study raises the question of whether work conditions should be considered in efforts to prevent diabetes. Globally, more than 285 million people have type 2 diabetes and that burden is expected to grow to 439 million by 2030. In the U.S. alone, more than 25 million people have diabetes and if trends continue, one in three U.S. adults will be living with the costly chronic disease by 2050.
To read the full study, visit the Lancet.
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.