Evaluating Current Public Health Practices in Villa El Salvador, Peru

Catalyst Volume 6

Abstract

Initiatives in public health have gained more popularity in recent years due to their simplicity and effectiveness. The success rates of such projects depend heavily upon their adaptability to the community’s needs, which in turn depend on pre-existing health data. The purpose of this study was to formally quantify and evaluate the current health practices in Villa El Salvador, Peru. The study formally verifies the need for clean water and preventative care education public health projects to address the growing health concerns in this specific community.

Introduction

Public health is defined as the science and art of preventing disease, prolonging life, and promoting health and well-being through organized community effort for the sanitation of the environment.¹ While such practices can enhance health in many settings, recently the trend has been to study and apply these principles to smaller communities. The motivation in targeting smaller communities lies in enacting grassroots health movements, spreading awareness of basic, yet essential health measures to a specific population. By tailoring these efforts, specific areas of health salient to the community are emphasized. While their level of success has varied, the inception of such projects has drawn awareness to the field of public health and basic health issues worldwide.

Successful and sustainable public health programs must be well adapted to the unique needs of their target community.² However, a component frequently overlooked is feedback from the community. Prior data describing community needs is essential when planning and piloting person-specific initiatives. Despite the correlation between the availability of current public health data and the success of public health initiatives, many small communities do not have the resources to enact widespread studies.

One such example is Villa El Salvador, a community of over 400,000 people in Lima, Peru.³ Founded on May 11, 1971 by a group of nearly 200 families, Villa El Salvador continues to remain as a “self-managed” community with both commercial and residential areas. After many organized protests, most of Villa El Salvador today now has electricity and water. However, poverty is a major issue in the community. An estimated 21.9% and 0.8% of the population falls into the categories of “poverty” and “extreme poverty” respectively, according to official Peruvian standards: these levels correspond to a family of four members living with $2/$1 daily, respectively.⁴

As a result, nonessential “luxuries” are often spared from the budget. Healthcare is often one such example. Most people cannot afford the medical services offered by the four major hospitals in the area.⁵ In response, smaller community health clinics including “San Martín de Porres Centro de Salud” have attempted to bridge the socioeconomic gap of attaining quality care. People attend these clinics to receive affordable, and sometimes even free, medical attention. While such establishments have continued to serve the people of Villa El Salvador, many are unable to periodically seek medical assistance. A heightened awareness of preventative care is severely lacking in the community, which can be addressed through targeted public health initiatives. Unfortunately, accurate and current health data for Villa El Salvador does not exist.

The purpose of this study is to formally evaluate the health practices of people in Villa El Salvador. Through this initiative, I aim to provide basic, yet meaningful data through the use of surveys for future campaigns in public health and preventative care. Through the information attained from this study, I aspire to provide insight into valid points of focus for the overall improvement in community health. By attaining specific, quantifiable data firsthand from the citizens, future public health projects will be able to mold their initiatives based off of specific community needs and therefore enact consequential and sustainable change.

Experimental

I designed a public health survey to study potential factors contributing to the health issues in Villa El Salvador. After researching prior literature and assessing community needs I targeted several factors: exercise, nutrition, sources and amount of water, hindrances for medical attention, time spent washing hands, and vaccinations. The final version of the survey featured seven questions targeting the areas mentioned. All seven questions featured multiple-choice responses to minimize time spent completing the survey and maximize regularity to yield meaningful results.

I first distributed surveys on June 19, 2012 during the San Martin de Porres Centro de Salud Health Campaign, which offered free healthcare at a local park in Villa El Salvador. This event was specifically chosen as a starting point of the study to collect an accurate sample of the population, minimizing socioeconomic inequalities. The surveys were then distributed in San Martin de Porres Centro de Salud in the mornings for the following week to collect more responses. Respondents were randomly chosen as they waited for medical services offered at the center. After giving informed consent, subjects were told to mark the best response for each question with the exception of the final vaccine question, where all pertinent answer choices were selected.

A total of 98 responses were attained in the two-week span. Thirty-six respondents were between the ages of 15-30, 53 from the ages of 31-50, six from the ages of 51-65, and three from 65 years and above. Since most of the patients of the clinic are females, 19.4% of males were surveyed. Besides the differences in gender, the sample population accurately reflects the demographics of Villa El Salvador.

Results

From the population sampled, 19.4% of participants reported consuming more than two servings of fruits and vegetables combined (Figure 1). The majority of the population reported consuming 1/2 or one serving (35.7% for both categories, respectively). Furthermore, only 12.5% of the population above the age of 50 reported consuming more than one serving of fruits and vegetables daily. Finally, two percent of the respondents reported consuming no fruits and vegetables.

Forty percent of the sample population reported consuming eight or more glasses of liquid daily (Figure 2). According to the results attained, 33.7% of the people consume less than two servings of liquid. The most common source of water for the population sampled was tap by an overwhelming percentage (53%, Figure 3). Both bottle and cistern options yielded 23.5% respectively.

Cost served as the biggest obstacle to periodically visit a doctor for 38.8% of survey participants (Figure 4). However, many 17.3% of the respondents (17.3%) reported distance from a medical facility as the most significant hindrance, while fear for seeing a medical professional was the next most selected response (11.2%). It is important to note that when presented with this question, 9.2% of the respondents reported “trabajo” or work as their answer even though it was not an answer choice.

The majority of the population (52%) reported spending 10 seconds or less washing their hands per attempt, while the second most common response (30.6%) reported was up to twenty seconds (Figure 5). Only 11.2% reported spending up to 30 seconds per attempt, while more than 30 seconds was the least common response (6.2%).

Discussion

A majority of the respondents reported consuming either ½ or 1 serving of fruits and vegetables together. According to the United States Department of Agriculture, individuals should consume at least five to seven daily servings of fruits and vegetables combined, depending on factors such as gender and age.⁶ This survey finding contrasts the steady decrease in malnutrition Peru experienced nationwide from 2005-2010 and most significantly in small, semi-urban areas such as Villa El Salvador.⁷ It is clear that the majority of Peruvians are getting something to eat, at least from the perspective of the Peruvian government.

The issue then arises of what is being consumed. According to the World Health Organization, Peru is expected to have about two million people with diabetes by 2030, triple of what it had in 2010.⁸ The increasing prevalence of heart disease has also been documented⁹ An unhealthy diet may point to the rise in noncommunicable diseases in this community. The data I acquired from the study points to the reduced consumption of fruits and vegetables could serve as major reason for why this disturbing trend is present.

The third question on the survey originally asked for asked for a respondent’s daily water consumption, but much of the Peruvian diet involves juice, soup, and other milk-based products that contain water. Hence, to get an accurate tabulation of water intake, I included juice and milk in the survey. Experts recommend drinking seven to eight glasses of water daily. The majority of people consume two to five glasses of water-based liquids according to the data I attained. In addition, most people cited “tap” as their major source of water. While initiatives promoting the healthy benefits of drinking water would prove to be helpful by emphasizing the importance of increased water consumption daily, the issue of attaining clean water sources must also be addressed.

The principle of preventative care is often deemphasized in many small communities worldwide, regardless of socioeconomic status. For a community such as Villa El Salvador, the importance of this concept multiplies. Realistically, the majority of people in Villa El Salvador cannot financially afford to see a specialized healthcare professional. Hence, regular checkups with a physician to help monitor physical well-being serve as paramount health checkpoints for patients. The real issue is when even these checkups become too expensive. As discussed in the results section, this is unfortunately the case; the majority of people reported cost as their biggest obstacle to seeing the doctor periodically. Keeping in mind that they surveyed population is from a clinic that already provides relatively inexpensive medical services compared to those provided “on the street”, or outside of the clinic, the results are quite discouraging.

The health clinic cannot do much to reduce the cost; most of the employees are volunteers that work for little or no money, making layoffs and reductions in salaries imprudent. Paperwork and other administrative tasks could be streamlined via computers to help improve efficiency, but such a change would not occur overnight. Furthermore, there is always the issue of funds. While places such as the health clinic could redistribute their prices towards their more popular revenue streams and incentivize those that come often, simple public health outreach solutions could prove to be quite effective. Demonstrations in the community focusing on self-check and self-evaluations would increase accountability while upholding the idea of preventative care. In addition, other healthcare professionals besides doctors could make periodic home visits to “high-risk” patients as part of the care they receive from the Centro de Salud. While the latter would require more human resources, it could potentially give students from nearby universities the opportunity to engage in basic physical examination practices. This would be a unique outreach initiative the Centro de Salud could pilot to reduce its own patient inflow.

Hand washing is one of the most popular public health topics in terms of universality and applicability.¹⁰ Preventing the spread of infections and illnesses is key for a preventative care approach. The Centers of Disease Control and Prevention recommends washing hands for at least 20 seconds, and up to 40 seconds depending on the drying mechanism. Over 80% of the sample population reported washing hands for less than 20 seconds. This helps to explain the spread of sicknesses and parasites in Villa El Salvador. The frequency of hand washing could also play a role, though this was not evaluated in this study. There have been initiatives involving hand washing in Villa El Salvador (Centro de Salud has one once a year), but these projects are targeted towards children. While it is important for children to learn the proper technique, it is just as important (if not more) for adults to learn as well. The adults usually prepare the food, the latter serving as a major source of illness. Furthermore, they serve as role models for their children; if they engage in proper hand washing, their children are more likely to as well¹¹ In essence, while the community has shown its support for hand washing, the older generation must take the issue more seriously.

While access to care has improved significantly in Villa El Salvador with the emergence of smaller clinics, there is still room for much improvement for the overall health of the community. The aim of this study was to quantify the current health practices of the people of Villa El Salvador to provide community-specific data. The effectiveness of follow-up studies would increase if more people were surveyed in different areas of Villa El Salvador, particularly people over the age of 50 and males. Furthermore, delving into one specific topic, such as nutrition and hand washing, would provide more depth for the respective facet of health than this study presented. Regardless, the study was successfully completed and conveys tangible information concerning the health practices the target community. It is the hope that the investigation served as a solid starting point for prospective public health initiatives in Villa El Salvador and Peru at large.

Acknowledgements

I would like to thank Enrique Bossio Montellanos, Director of Cross Cultural Solutions in Lima, Peru and Carol Soto, Head Coordinator of the San Martin de Porres Centro de Salud and the entire San Martin de Porres Centro de Salud staff for all of their support. Also, I would like to thank The Rice University Loewenstern Fellowship, and the Rice University Community Involvement Center for funding my trip. Finally, a special thanks to Sarah Hodgkinson and Mac Griswold for all of their guidance.

References

1. Clinton County Health Department website. http://www.clintoncounty      gov.com/departments/health/aboutus.html (Accessed Jul. 7, 2012).
2. Trust for America’s Health: Examples of Successful Community-Based Public Health Interventions (State-by-State). http://www.cahpf.org/GoDocUserFiles/601.TFAH_Examplesbystate1009.pdf (Accessed Jul. 7, 2012).
3. Participant Handbook: Lima, Peru. New Rochelle: Cross Cultural Solutions, 2012.
4. Perspectivas Socioeconómicas para Villa El Salvador, Observatorio Socio       Económico Laboral, Lima Sur, Lima, Peru, Jul. 2009.
5. Portal de la Muncipalidad de Villa El Salvador. http://www.munives.gob.pe/index.php (Accessed Jul. 7, 2012).
6. Vegetables: Choose My Plate. USDA. http://www.choosemyplate.gov/food-groups/vegetables.html (Accessed Jul. 22, 2012).
7. Acosta, A. M. Working Papers at IDS. 2011, 367.
8. WHO Country and Regional Data on Diabetes. http://www.who.int/diabetes/facts/world_figures/en/ (Accessed Jul. 7, 2012).
9. Fraser, B. The Lancet. 2006, 367, 2049-50.
10. Vessel Sanitation Program. Centers for Disease Control and Prevention, http://www.cdc.gov/nceh/vsp/cruiselines/hand_hygiene_general.htm (Accessed Jul. 20, 2012).
11. Stephens, K. Parenting Exchange. 2004. 19, 1-2.

Eating Wheat: Avoiding the Bad and Getting the Good

Catalyst Volume 6

A bagel or bowl of cereal is common for breakfast, followed by a sandwich or burger for lunch. Dinner often stars pasta, pizza, or a casserole as the main dish. There is one ingredient that lurks in nearly every American meal.

Wheat. It’s the main ingredient in bread, the most purchased packaged food in the United States.¹ It plays an integral role in many diets, but if not correctly consumed, it can damage the human body. The harmful effects include increased risk of weight gain, cardiovascular disease, and even cancer.² To avoid adverse effects while reaping the benefits wheat offers, three factors should be considered: wheat type (whole-grain or refined), the portion size, and the accompanying ingredients.

Whole Grains Instead of Refined Grains

Guidelines by the United States Department of Agriculture (USDA) recommend Americans consume whole-grain rather than refined wheat. Currently, the average consumption of whole-grain foods is approximately one serving a day, falling short of the recommended three servings.³ Wheat grains are divided into three parts: endosperm, germ, and bran (Figure 1). Whole-grain wheat grains have the germ and bran intact. In contrast, refined grains that have the bran and germ separated from the starchy endosperm comprises 80% of the grain. Unfortunately, this processing robs wheat of the majority of its nutrients, which are concentrated in the bran and germ.

Whole grain wheat has nearly ten times more dietary fiber, five times as many vitamins and cancer-preventing phenolic compounds, and three times as many essential minerals including zinc, iron, and selenium (Table 1).

The extra dietary fiber of whole-grain wheat itself is a compelling reason to choose it over refined wheat. Increased consumption of dietary fiber has been observed to improve cholesterol concentrations, lower blood pressure, and aid in weight loss. These effects all reduce the risk for coronary heart disease, the leading cause of adult deaths in the United States.⁴ High-fiber foods facilitate metabolic effects and control caloric intake by increasing satiety. Dietary fiber, consisting of insoluble and soluble components, promotes gastrointestinal health as a probiotic for beneficial bacteria in the colon. Both fibers also provide cardiovascular benefits by lowering “bad” cholesterol, or LDL.

In the broader context of a person’s entire diet, high-fiber foods often have lower energy density and take longer to eat. These two traits promote satiety, curbing consumption of potentially unhealthy foods and lowering total caloric intake. Eating refined wheat, such as white bread and pasta, causes one to not only forego nutrients, but also consume more calories before feeling full. Overconsumption of calories coupled with physical inactivity are major risk factors leading to heart disease and obesity.⁵

Control Portion Size

In addition to considering what type of wheat one eats (e.g., wholewheat instead of white bread for toast in the morning), an equally important factor is quantity. Feasting upon large portions of wholegrain wheat regularly results in damaging spikes in blood sugar that can lead to an chronic state of Type 2 diabetes.⁶ Since diabetes is the leading cause of kidney failure in the United States and doubles the risk of stroke, its correlation with consumption of refined wheat is important to understand.⁷

The biochemical phenomenon underlying this link is called insulin resistance. Insulin is a hormone stimulating various tissues to store glucose from the blood as glycogen. When carbohydrates are digested, they are broken down into glucose, which is transported into the bloodstream, consequently increasing blood sugar levels. This causes pancreatic beta cells to synthesize insulin to convert the increased glucose into glycogen. When the body does not perform these functions well, the resulting condition is Type 2 diabetes.

Even though the USDA advises adding whole-grain wheat to one’s diet, USDA guidelines do not account for the spiking effect on blood sugar when a large portion is eaten in a short time frame. Their guidelines use a rating system called the glycemic index (GI) that is widely utilized in nutrition studies as a quality standard of carbohydrate foods.⁸ Wonder®, fully enriched white bread, has a GI of 71 while bread made of 80% whole-grain and 20% refined wheat flour has a GI of 52.⁸ In practical terms, these GI values indicate a 70% increase in blood sugar compared to the blood sugar increase caused by a comparable amount of pure glucose. Likewise, whole wheat bread causes an increase in blood sugar 52% of that caused by glucose. Based on the aforementioned pathogenic contribution of blood sugar spikes, the lower GI of whole-wheat bread quantitatively demonstrates its superiority over white bread.

However, consider the following: the Twix candy bar has an even lower GI of 44. Watermelon has a GI of 72. How does this make sense? The glycemic index fails to account for realistic portion sizes. When the foods are empirically tested on people for their effects on blood sugar, the quantities eaten are equivalent to 50 grams of carbohydrates. Three-quarters of a king-sized Twix bar constitutes 50 grams of carbohydrate, but so do 5 cups of diced watermelon. This difference in volume is due to the fiber and water content of watermelon.

Realistically, a person is likely to eat a whole king-sized Twix bar or one cup of diced watermelon in one sitting. Adjusting for actual serving sizes and assuming linearity, the Twix bar has what is now called a glycemic load (GL) of 58.7 and watermelon a GL of 14.4. As a more relevant implementation of GI values, glycemic load emphasizes control of portion sizes in eating carbohydrates. The GI value of whole-grain wheat is always lower than refined wheat vary, but the difference is small enough that one cup of refined flour pasta might be better than 2 cups of whole-wheat flour pasta in preventing Type 2 diabetes.

Watch Out for Accompanying Ingredients

The final factor to consider is that wheat is rarely eaten alone. In the processing and cooking to make it edible, wheat is nearly always mixed with other ingredients that are potentially harmful. Most breads, pastas, pancakes, cereals, and other wheat products have at least five ingredients trailing behind the primary wheat ingredient, which are broadly classified as preservatives, sweeteners, emulsifiers, leavening agents, flavor enhancers, and dough conditioners. All of these additives to wheat affect short-term feelings after consumption as well as long-term effects on the body. In particular, one should avoid partially hydrogenated oils and moderate high-fructose corn syrup.

Added as dough conditioners and preservatives, partially hydrogenated oils are considerable factors in coronary artery disease, which causes at least 30,000 premature American deaths per year.⁹ They contain trans fats, which have been unequivocally linked to lowering “good” high-density lipoprotein (HDL) cholesterol and raising “bad” low-density lipoprotein (LDL) cholesterol. Although large companies have removed trans fats, including partially hydrogenated oils, from foods such as Kraft’s Oreos in response to mounting criticism beginning in 2005, numerous food companies still include partially hydrogenated oils in their wheat products. For example, cake mixes, packaged baked goods, and peanut butter are commercially made with partially hydrogenated oils on a regular basis because they simplify manufacturing and reduce costs while increasing the final product’s shelf life. Manufacturers obfuscate this addition by stating the trans fat content of foods as “0g” on nutrition labels. This is allowed because 0.5 grams of trans fat is one serving. However, less than 0.5 grams of trans fat per serving can accumulate when consuming multiple servings of foods such as chips or crackers. Instead, check for the words “partially hydrogenated” or “shortening” in the ingredients list.

While partially hydrogenated oils are conclusively life-threatening, high-fructose corn syrup (HFCS) is a controversial additive. Manufacturers favor the use of HFCS as a sweetener in wheat products due to lower cost, sweeter taste, and higher miscibility. Scientists hypothesize that corn-derived sugar has endocrine effects that lead to obesity, Type 2 diabetes, and metabolic syndrome.⁸ Insulin and leptin are key hormone signals that regulate a person’s sense of hunger, but consumption of high-fructose corn syrup depresses these internal signals from controlling calorie intake. Another consequence of foods sweetened with HFCS is plaque buildup inside the arteries.¹⁰ Nearly any sweet good made from wheat will likely contain HFCS. Although data about its health effects are still inconclusive, HFCS should be avoided.

Being a health-conscious consumer of wheat can mean significant changes in daily choices of which foods to eat and how to eat them. Whole grains provide more fiber and life-boosting nutrients than refined grains, but accompanying ingredients in available food choices need to be considered as well. More importantly, the impacts of wheat on blood sugar need to be controlled by consuming a commensurate amount of fruits and vegetables. Awareness and application of these principles are the main steps to avoiding the bad and getting the good of wheat.

References

1. Nielsen Homescan Facts, The Nielsen Company. http://www.marketingcharts.com/television/nielsen-issues-us-top-10-lists-for-2007-2700/nielsen-2007-top-10-cpg-purchased-us-homes.jpg/(Accessed Jan. 15, 2013).
2. Slavin, J. L. Amer. J. Clin Nutr. 1999, 70, 459S-63S.
3. Cleveland, L. E. J. Amer. Coll. Nutr. 2000, 19, 331–8.
4. Anderson, J. W. Nutr. Rev. 2009, 67, 188–205.
5. Swinburn, B. Public Health Nutr. 2007, 7, 123–46.
6. Liu, S. J. Amer. Coll. Nutr. 2002, 21, 298–306.
7. World Health Organization: Diabetes Fact Sheet, Media Centre. 2012 http://www.who.int/mediacentre/factsheets/fs312/en/index.html (Accessed Jan. 15, 2013).
8. Foster-Powell, K. Amer. J. Clin Nutr. 2002, 76, 5–56.
9. Ascherio, A. Amer. J. Clin Nutr. 1997, 66, 1006S–10S.
10. Stanhope, K. Amer. J. Clin Nutr. 2008, 88, 1733S-7S.
11. General Mills. What is Whole Grain, Anyway? Demystifying Whole Grains. http://wholegrainnation.eatbetteramerica.com/images/content/facts_seed.jpg (Accessed Jan. 15, 2013).
12. Thompson, L. U. Contemp. Nutr. 1992, 17.

The Bridge from Discovery to Care: Translational Biomedical Research

Catalyst Volume 6

Since the 1970s, both the number of molecular biology PhD scientists and the amount of biomedical research have grown rapidly, greatly expanding our knowledge of the cell.¹ This explosion has led to incredible scientific achievements, including development of the polymerase chain reaction in the 1980s and completion of the Human Genome Project in 2003.^2-4 The focus of research has shifted from single genes to all genes, from single proteins to all proteins. Neither scientists nor pharmaceutical companies, however, have been able to keep pace with the sheer quantity and complexity of modern biomedical research. Additionally, while the majority of medical researchers were once physician-scientists in the 1950s and 1960s, they are predominantly PhDs today.¹ Questions of basic and clinical research, once addressed side by side, are now separate.

The widening gap between scientific discovery and therapeutic impact is a result of these changes. In the United States, the dramatic increase in spending for pharmaceutical research and development has been offset by a disappointing decrease in therapeutic output (Figure 1). As this paradox becomes more apparent, translational research, which aims to convert laboratory findings into clinical successes, emerges as an increasingly important endeavor.^5,6

In 2006, the U.S. National Institutes of Health (NIH), the largest source of funding for medical research in the world, focused its attention on translational research by launching the Clinical and Translational Science Awards program.^7,8 However, implementing effective translational research is both time- and labor-intensive. According to Dr. Garret FitzGerald, Director of the Institute for Translational Medicine and Therapeutics at the University of Pennsylvania, challenges include a lack of human capital with translational skill sets, relevant information systems, and intellectual property incentives.⁹

During his leadership of the NIH from 2002 to 2008, Dr. Elias Zerhouni witnessed the consequences of clinicians lacking in training on the speed of scientific advancements for patient care.^10,11 Beyond the need for manpower, an open culture of communication between scientists and clinicians is necessary.

Drug development is a one-way process from benchside to bedside in which scientists identify drug targets, conduct clinical tests, and develop marketable drugs. Many argue, however, that the communication must run in the opposite direction, too; feedback from clinical trials and doctors is valuable because understanding their concerns allows researchers to improve drug development.¹² The third challenge derives from current institutional practices and regulations. An investigator’s publication record rather than their efforts to advance medicine determines success.¹³ Research funding is also granted on an individual basis, which does not promote the collaboration necessary for successful translational research. Lastly, the regulatory and patent processes governing drug development require much expertise and time to navigate, which offer little incentive for researchers to become involved.¹

To better integrate basic science with clinical science progress, countries such as the United States are building a new team of leaders in all aspects of clinical research: medicine, pharmacology, toxicology, intellectual property, manufacturing, and clinical trial design and regulation.¹³ Dr. Francis Collins, Director of the NIH since 2009, has called for a partnership between academia, government, private, and patient organizations to repurpose molecular compounds previously failing in their original use.^15,16 Historically, Collins referred excitedly to azidothymidine, a drug originally developed to treat cancer that later treated HIV/AIDS.¹⁴ Tremendous potential lies in applying scientific developments to other contexts, and the NIH has already drafted policy for this purpose.¹⁵

However, the growing support for translational research does not diminish the importance of basic scientific research, which poses the most interesting questions. Translational biomedical research creates an efficient environment for scientists to work at the interface of basic science and therapeutic development and to help fulfill the social contract between scientists and citizens. The full impact of translational initiatives has yet to be seen because the success of drug development, which can take up to 20 years, cannot be evaluated easily or quickly. For now, we can hope that integrating the work of scientists and clinicians will benefit both the patients, who await treatment, and the researchers, who only dream of seeing their discoveries transformed into new therapies for disease.

References

1. Butler, D. Nature. 2008, 453, 840–2.
2. Smithsonian Institution Archives. Smithsonian Videohistory Collection: The History of PCR (RU 9577). http://siarchives.si.edu/research/videohistory_catalog9577.html (Accessed Jan. 15, 2013).
3. National Center for Biotechnology Information (NCBI). Probe, Reagents for Functional Genomics: PCR. http://www.ncbi.nlm.nih.gov/projects/genome/probe/doc/TechPCR.shtml (Accessed Jan. 15, 2013).
4. Human Genome Project Information. About the Human Genome Project. http://www.ornl.gov/sci/techresources/Human_Genome/project/about.shtml (Accessed Jan. 15, 2013).
5. CTSI (Clinical and Translational Science Institute) at UCSF. Translational Medicine at UCSF: An Interview with Clay Johnston. http://ctsi.ucsf.edu/news/about-ctsi/translational-medicine-ucsf-interview-clay-johnston (Accessed Jan.15, 2013)
6. Helwick, C. Anticancer Drug Development Trends: Translational Medicine. American Health & Drug Benefits. http://www.ahdbonline.com/article/anticancer-drug-development-trends-translational-medicine (Accessed Jan. 15, 2013).
7. National Institutes of Health (NIH). About NIH. http://www.nih.gov/about/ (Accessed Jan. 15, 2013).
8. National Institutes of Health National Center for Advancing Translational Sciences (CTSA). About the CTSA Program. http://www.ncats.nih.gov/research/cts/ctsa/about/about.html (Accessed Jan. 15, 2013).
9. Pers. comm. Dr. Garret FitzGerald, Director of the Institute for Translational Medicine & Therapeutics at the University of Pennsylvania.
10. NIH News. Elias A. Zerhouni to End Tenure as Director of the National Institutes of Health. http://www.nih.gov/news/health/sep2008/od-24.htm (Accessed Jan. 15, 2013).
11. Wang, S.S. Sanofi’s Zerhouni on Translational Research: No Simple Solution. The Wall Street Journal. Health Blog 2011 http://blogs.wsj.com/health/2011/05/20/sanofis-zerhouni-on-translational-research-no-simple-solution/ (Accessed Jan. 15, 2013).
12. Ledford, H. Nature. 2008. 453, 843-5.
13. Nature. 2008, 543, 823.
14. TEDMED 2012. Francis Collins. http://youtu.be/spUoPC_TU_8 (Accessed Jan. 15, 2013).
15. Wang, S. Bridge the Gap Between Basic Research and Patient Care, NIH Head Urges. The Wall Street Journal Health Blog. http://blogs.wsj.com/health/2012/04/11/bridge-the-gap-between-basic      research-and-patient-care-nih-head-urges/ (Accessed Jan. 15, 2013).

The Illusion of Race

Catalyst Volume 6

Race is one of the most pervasive features of American social life; neglecting the concept of race would be like questioning the existence of gravity. Though we would like to consider our nation a post-racial society, we still place great importance on race by asking for it on forms ranging from voter registration to the PSAT. However, many would be surprised to realize that race does not have a biological basis – there is no single defining characteristic or gene that can be unequivocally used to distinguish one race from another.¹ Rather, it is a manmade concept used to describe differences in physical appearance. Yet, we have internalized the social construct of race to such a degree that it seems to have genetic significance, masking the fact that race is actually something we are raised with. That a simple internalized ideology creates disparities in contemporary American society, from socioeconomic status to healthcare accessibility, illustrates the urgency of exposing this myth of race.

Throughout American history, racial connotations have been fluid, with different ethnographic groups falling in and out of favor based upon societal views at a given time. Race was originally conceived as a way to justify colonialism. European colonizers institutionalized their ethnocentric attitudes by creating the concept of race in order to differentiate between the civilized and the savage, the Christians and the heathens. This dichotomy facilitated mercantilism, the economic policy designed to accrue astronomical profits for the European countries through the exploitation of “inferior” races. Scholars of Critical Race Theory show, more generally, that the boundaries of racial categories shift to accommodate political realities and conventional wisdom of a given time and place.²

This definition of race changed in the United States over the centuries. For example, when the Irish and Italians first immigrated in the early 20th century, they were seen as “swarthy drunkards” – clearly not part of the white “elite.” Within two generations, however, these same people were able to assimilate into the Caucasian-dominated culture while African-Americans were still considered a separate entity. Similarly, during the era of the Jim Crow laws, courts had the power of determining who was black and who was not; in Virginia, a person was considered to be black if he or she was at least 1/16th African-American; in Florida, a black person was at least 1/8th African-American; and in Alabama, having even the smallest sliver of African-American heritage made a person black.³ Thus, a person could literally change race by simply moving from one state to another. Today, the commonly defined race classifications, as specified by the US Census, include White, Black, Asian, American Indian or Alaska Native, Pacific Islander or Native Hawaiian, Other, and Multiracial. Because there is no scientific cut-offs to determine what race a person is, racial data is largely based on self-identification, which points to its lack of biological legitimacy. For example, 30% of Americans who label themselves as White do not have at least90% European ancestry.⁴

We may think our conceptualization of race is based upon biological makeup, but it is actually an expression of actions, attitudes, and social patterns. When examining the science behind race, most scholars across various disciplines, including evolutionary biology, sociology, and anthropology, have come to the consensus that distinctions made by race are not genetically discrete, cannot be reliably measured, and are not meaningful in the scientific sense.⁵

Some argue that race is a genetic concept based upon a higher incidence of particular diseases affecting certain races. However, purely hereditary diseases are extremely rare. For example, 1/2300 births for cystic fibrosis, 1/10000 births for Huntington’s disease, and 1/3000 births for Duchenne’s muscular dystrophy.⁶ Rather, diseases often reflect shared lifestyles and environments instead of shared genes, because factors such as poverty and malnutrition are also often “inherited” through family lines. Even genetic polymorphisms in hemoglobin, which lead to populations with lower susceptibility to malaria, can be partly explained by environmental factors.^6-8 Thus, diseases traditionally tied to certain races cannot be explicitly attributed to genes, discrediting the idea that races are genetically disparate. Genetic differences are better described as percentages of people with a particular gene polymorphism, which change according to the environment.⁶

Racial groupings actually reflect little of the genetic variations existing in humans. Studies have shown that about 90% of variations in human genetics is present within a population on a continent, while around 10% of genetic variation occurs between continental populations.¹ Variation in physical characteristics, the traditional basis for determining race, does not imply underlying genetic differences. When we internalize the false ideology that race is genetic, we are mistakenly implying that there are human subspecies.

Although race is a social construct, it has a widespread influence on society, especially in the United States. In particular, minorities face disadvantages in numerous areas ranging from healthcare to education.^7,8 Reports about Mitt Romney’s rumored adoption of a darker skin tone when addressing Latino voters or statistics indicating that the median household wealth of whites is 20 times that of blacks reinforces the existence of a racialized society.⁵ This is shocking and disturbing; race may not be real, but its effects contribute to real inequality. Once everyone understands this racial illusion, we can begin making effective change.

References

1. Bamshad, M. J.; Olson, S. E. Does Race Exist? Scientific American, New York City, Nov. 10, 2003, p. 78-85.
2. Calavita, K. Invitation to Law and Society: An Introduction to the Study of Real Law. University of Chicago Press: Boston, MA, 2007.
3. Rothenberg, P. S. Race, Class, and Gender in the United States, 7th ed.; Worth Publishers: New York, NY, 2007.
4. Lorber, J.; Hess, B. B.; Ferree, M. M.; Eds. Revisioning Gender; AltaMira Press: Walnut Creek, CA, 2000.
5. Costantini, C. ABC News. http://abcnews.go.com/ABC_Univision/News/mitt-romneys-tan-draws-media-fire-makeup-artist/story?id=17290303       (Accessed Oct. 26, 2012).
6. Pearce, N. BMJ. 2004, 328, 1070-2.
7. Stone, J. Theor. Med. Bioethics. 2002, 23, 499-518.
8. Witzig, R. The Medicalization of Race: Scientific Legitimization of a Flawed Social Construct. Ann. Intern. Med. 1996, 125, 675-9.
9. Tavernise, S. The New York Times. http://www.nytimes.com/2011/07/26/us/26hispanics.html?_r=0&pagewan (Accessed Oct. 26, 2012).

Nature vs Nurture of Politics

Catalyst Volume 6

If you voted in last year’s election, what made you choose the candidate for whom you voted? Was it the platform, the party, or perhaps your genes? Since Mendel and his peas, the idea that genes affect physical traits has greatly influenced science. However, their role may be greater than we thought. Aristotle first posed the question of nature vs nurture, which is now the debate surrounding the relative importance of one’s genes (nature) against one’s upbringing (nurture) in determining physical and behavioral characteristics. For instance, is one’s intelligence an innate quality or one based on years of education? If genes are involved in political ideology, does that mean political freedom is limited? Do we have a choice in voting? The answer to the age-old question is more complex, yet nowadays, more people recognize the idea that both nature and nurture are involved in trait determination.

Family values, education, and the media were originally thought to determine an individual’s political behavior. The scientific community has gradually come to embrace political views as a legitimate factor in the nature vs. nurture debate. In fact, the study of genetic influence in political decisions has a name: genopolitics.¹ For instance, an early study of the topic found that identical twins show more similarities than non-identical twins in voting behavior.²

Furthermore, although many still believe environmental influences play the sole role in determining political attitudes, a recent articles suggests that genes influence political preferences.³ This harks back to the notion that both nature and nurture are important in the development of an individual’s behavior. Whether your vote is liberal or conservative is not determined by a single gene, but rather by a combination of genes and regulatory pathways with environmental factors from one’s political principles.²

However, genetics does not play a roles in all political traits. In particular, because political parties are transient and vary between countries and across time, only nurture plays a role in party identification. A liberal in American politics is not the same as a liberal in European politics. On the other hand, most genopolitic researchers agree that genetics does influence the ideology (e.g., conservatism or liberalism) of group organization, as a relatively timeless matter.⁴ For example, your heritage might make you favor a powerful government over a weak government but would not directly influence you vote for a Democratic nominee over a Republican nominee.

How exactly genetics could influence your vote is difficult to understand. Hatemi and McDermott conceptualize that our Prehistoric ancestors faced issues with out-groups (immigration), security (foreign policy), and welfare (resource management), among others. Through evolutionary processes occurring over thousands of years, these issues became polarizing traits that are heritable.² This by no means signifies that one ideology is more “fit” than another simply because it has dominated in the past.

These natural factors determine conservative vs. liberal preferences. However, environment may play a larger role in directing most individual political choices. More research is necessary to show that the influence of genes on political ideology cannot be explained by purely environmental influences.⁶

References

1. Stafford, T. BBC Future. http://www.bbc.com/future/story/20121204-is-politics-really-in-our-genes (Accessed Dec. 4 2012).
2. Biuso, E. Genopolitics. New York Times, New York, Dec. 14, 2008, p. MM57.
3. Haterni, P. K. Trends in Genetics. 2012, 28(10), 525-33.
4. Alford, J. R. Ann. Rev. Pol. Sci. 2008, 15(2), 183-203.
5. Body politic: THe genetics of politics, The Economist, London, Oct. 6, 2012.
6. Haterni, P. K. JOP. 2011, 73(1), 271-85.