Teaching Ukraine to Fish

Initial reports show that the ceasefire in Ukraine may be holding. Large artillery pieces are being pulled back from the front lines by the separatist and Ukrainian government forces. Yet there is still sporadic fighting between government and separatist forces along the front lines of the conflict. The question on everyone's mind is if this lull in the conflict is step towards peace or are the separatists using this time to resupply so that they can push further into government controlled territory?

The movement of heavy artillery by separatists and the Ukrainian government forces away from the front lines would indicate that the ceasefire may be working since the heavy artillery is giving the separatists the upper hand against Ukraine's government forces. However, sources indicate that the separatist commanders still have the intention of capturing a few more areas in Eastern Ukraine with strong pro-Russian leanings. Therefore, the separatists may be using this lull in the fighting to regroup and resupply.

A renewal in the fighting may be a boon to the Russian President Vladimir Putin. The intervention of Russia in the conflict has made Putin increasing popular in certain segments of Russian society. Furthermore, renewed fighting would pull some of the media spotlight from the recent assassination of a vocal critic of President Putin, Boris Nemtsov.

The Russian President is not the only one who benefit from the renewed conflict. The Ukrainian government has effectively lost control of the far eastern half of their country and they want it back. The Ukrainian government has already requested arms assistance from its Western allies, a topic which is discussed in detail in the previous article "War and Peace in Ukraine". While the request was made at a time when ceasefire was not initiated, the request has not been yet been publicly withdrawn. No political leader wants to preside over the break up of his country.

The violation of Ukrainian sovereignty by the Russian government, both through the their direct and indirect support of the separatists, is an act that should not go unchallenged by the rest of the world. The sanctions on Russia are not a stand alone solution to the problem just like the the ceasefire is not a lasting peace. Even with a ceasefire, which was hailed in the West as a victory, Ukraine still lost ground to the separatists. The separatist victory in Eastern Ukraine showed the Russians that they could intervene with virtual impunity in Eastern European countries they share a border with.

Whether or not the separatists resupply themselves during the ceasefire, the Ukrainian government should resupply and, the West should help. Ukraine is a country with a democratically elected government that is being bullied. The West may not be able to fight Ukraine's battle but, they can provide Ukraine with the necessary assistance to help them defend their democracy.

There are those who would argue that by providing weapons to Ukraine the West is providing fuel to the fire. However, this scenario is different. The West would be supporting a democratically elected government. This is different than Syria, for example, where the rebels have no clear leadership and in some cases are colluding with religious fundamentalists.

The West is a beacon, not just for immigrants looking for a better life but, also for countries that want to be democracies. If Ukraine is not supported in its time of need it will send the wrong message to other pro-democracy governments around the world. As the old saying goes, give a man a fish and he will feed himself today but, teach a man to fish and he will never go hungry again. Giving Ukraine a ceasefire will provide them with a temporary peace but, providing them with with the support they need to earn their peace themselves may prove to be the long term solution.

Please Walk Calmly Towards the Grexit?

With Germany's denial of the extension for Greece's deadline on loan payments this week, it is becoming increasingly likely that Greece will exit from the Euro. The Greek debt talks have stalled on one question. Will Greece abide by the austerity terms that are a condition of its bail-out?

Earlier this week The True Blue Conservative published an article called "Death and Life in Greece" about the public health problems that austerity has contributed to inside Greece. When combined with the problems of unemployment (the Greek government is a major employer inside Greece) that austerity has already contributed to, the Greek public is unwilling to continue suffering austerity measures that are a condition of their bail-out. This sentiment was made clear when the people of Greece voted in the government of Alexis Tsipras, who ran on a platform that was strongly against austerity.

If the Greeks do not follow the austerity measures and Germany continues with its economic brinkmanship then Greece's exit from the Euro is very likely. However, this does not have to be the case. The terms of sovereign loans are often renegotiated. The original terms on which Greece was loaned money are not set in stone, especially when one of those terms, austerity, is the only major obstacle. The alternative to renegotiating the terms is to allow the Greek government to default, which is not in anyone's interest.

The one point that most parties involved in the negotiations agree on, including Germany and Greece, is that Greece needs to honor its debts. This is a solid foundation on which the terms of the bail-out can be re-negotiated. The first step to a possible solution is for Germany to reverse their position and grant Greece a short term extension on the loan deadline. The extension does not have to be a full six months, it can be shorter. This move allows all those involved in the negotiations a moment of calm that will allow cooler heads to prevail. A temporary extension will allow for the talks to continue and, increase the chances that Greece will pay its debts and, avoid default and exit the Euro.

Of course, both sides could maintain the status quo which will lead to the obvious result. However, Greece's default and exit from the Euro is only the short term effect. The long term consequences could be disastrous for the European Union and other global economies. Also, allowing Greece to exit from the Euro may send the wrong message, to other struggling economies in the Euro-zone, that the Euro-zone is a fair weather organization. Countries are welcome to it when their economies are doing well but, everyone is on their own when they need assistance.

Furthermore, weakness in the European Union at this time is deleterious for foreign policy. A strong European Union is key to preventing or countering any future aggression by Russia (the kind seen in Georgia and Ukraine) in European affairs.

The Euro is the first currency union in Europe that has been successful. Multiple previous attempts have been made and they failed. To risk the potential break up of the currency over debt repayment terms would be unfortunate, not only economically but, also geopolitically. The crisis with Greece is a significant challenge for the Euro-zone but one that they have the ability to overcome. The alternative to succeeding together is failing alone.

Death and Life in Greece

Greece has been embroiled in a fiscal crisis since 2008. Since that time Greece has been in the global economic spotlight. Greece became a petri dish for a macroeconomic experiment. The European Union, led by Germany, pushed economic austerity as a solution to the Greek debt crisis. The solution that was pushed on Greece was to curtail government spending at a time when Greeks needed the most assistance from their government. The result was mass unrest inside Greece, which was widely reported by most media outlets. However, the story about the effect on the health of Greeks was lost.

According to the OECD (Organization for Economic Co-operation and Development, an economic and  policy research forum comprised of 34 democracies including the Greece and the United States) health spending has dropped in Greece due to an overall reduction in government spending to help manage Greece's budgetary deficit. Furthermore, according to current data the reduction in health spending has occurred every year from 2009 to 2012. Greek health expenditure has decreased 25% when compared to levels in 2008.

An example of the reduction in health expenditure is decreased spending on pharmaceuticals. In general, from 2010 to 2012, OECD countries reduced spending on pharmaceuticals. However, Greek pharmaceutical spending was significantly decreased when compared to that of the OECD countries. For example, in 2012, OECD countries reduced pharmaceutical spending by 2.2% overall. During the same 2012 time period Greece reduced its pharmaceutical by approximately 18.4%.

Not surprisingly, people have found it increasingly difficult to afford healthcare. According to statistics from the European Union there has been a 47% increase in the number of people who feel that they have not been able to access necessary healthcare.

How as this reduction in government spending affected health outcomes? Research published in the Lancet (a renowned scientific journal) shows that infant mortality increased 43% from 2008 to 2010.    
Another major health indicator that causes alarm is the significant increase in the number of HIV infections. According to research from the University of Cambridge observed HIV infections increased among drug injection users from 15, in 2009, to 484 in 2012. This type of increase is unfortunate but, not surprising when considering that the reductions in government health spending can affect public health programs that provide sex education, condoms and, needle exchanges.

Physical health was no the only outcome affected. According to research from the London School of Hygiene and Tropical Medicine depression among Greeks increased 2.5 times from 2008 to 2011. Another mental health related indicator that causes concern is the increased rate of suicide among Greeks. Between 2007 and 2011, the suicide rate increased by 45%.

A public health crisis usually follows a political or financial one. In the case of Greece, the European Union has the opportunity to ease human suffering. Rather than pushing simple austerity as the solution to the Greek debt crisis the European Union can tailor economic assistance to Greece. Assistance can be provided that both promotes Greek fiscal responsibility for the future but, reduces the negative effect of the debt crisis on the public health of Greece. The European Union will benefit from a stronger Greece. A healthier Greece is a stronger Greece.

War and Peace in Ukraine

If someone had asked over a year ago, what countries are going to dominate foreign policy discussions few would have included Ukraine on the list. Now the United States, along with its European and NATO allies, are deeply involved in discussions with Russia and Ukraine to find a peaceful resolution to the conflict.

As the peace talks continued there was also a debate going on over the necessity of providing the Ukrainian military with defensive weapons. The Separatists in Eastern Ukraine have the support of the Russia. This support has allowed them to field heavy weapons on the battle field against the Ukrainian military often giving them an advantage.

Even with a cease fire that is now in place there is no guarantee that it will last. The Separatists have gained a significant amount of territory and they will not want to cede those gains through a peace process, especially when they believe that they have the advantage. Furthermore, the Ukrainian government is equally determined to regain lost ground. For the new leaders of the Ukrainian government their handling of this conflict will determine their political future and that of the country as well.

The European Union, however, is eager to see an end (or at least a temporary pause) to hostilities since they have the Greek debt crisis to manage. The German Chancellor, Angela Merkel, along with her European allies met with their Russian counterparts this week and had around the clock meetings to negotiate the ceasefire. At first glace this might be seen as a real effort to bring a permanent solution to the Ukraine crisis. However, the moment the ceasefire was negotiated the Angela Merkel and company left to handle the Greece crisis.

For the Russians, Ukraine is a much higher priority. The entire conflict started due to the Russian anxiety over loss of power as Ukraine formed stronger financial and political ties with the European Union and NATO. Russia sees Ukraine as being part of their sphere of influence politically, financially, and militarily. The strategically important port of Sevastopol in the Crimea is not the only reason that Ukraine is important to Russia. Ukraine also serves as buffer between Russia and, NATO and their European allies.

In 2008, when Russian interests in Georgia were threatened, they became involved militarily. Even after the French President at the time mediated peace talks, Russia did not cede ground. Even today Abkhazia and South Ossetia (once part of Georgia) are considered under Russian occupation. Georgia lost 20% of their internationally recognized territory by the end of the conflict. Russia's past behavior gives insight into their intentions for Ukraine. They will continue to support the Separatists in Ukraine with military and political support and use them as a proxy to maintain their influence in the region. Russia should not be allowed to destabilize Ukraine through war or peace. First Georgia's, and now Ukraine's sovereignty has been violated.

Through the peace process Russia should be required to move its forces back outside the internationally recognized borders of Ukraine. This would reduce direct Russian military support of the Separatists. However, the Russian withdrawal would not solve the Separatist problem. They can, and probably still will, be supported indirectly by Russia. To counter this problem, and help make Ukraine whole again, we need to supply the Ukrainian government with defensive weapons. The provision of these weapons to the Ukrainian government will give their government the tools to gain upper hand against the Separatists and unify the country. While the West cannot provide Ukraine the power to fight the whole Russian military they can help them defeat the Separatists.  

Actions speak louder than words. It is time for the United States, NATO, and their European allies to act. A truly lasting peace is valuable at any price, even if the cost is supplying Ukraine with defensive weapons.                    

Anti-Vaxx: Misunderstanding or Mistrust?

A mother brings a child with a high fever, diarrhea, and swollen lymph nodes into a hospital emergency room. The physician on duty orders a series of blood tests and quickly determines that the child has measles. At the same time, another child is admitted into a different hospital in the same area with similar symptoms and, is also determined to have measles. The local public health department is contacted and, they start a campaign to try and prevent a further spread of the disease.

This hypothetical scenario has now become a reality the United States where there are at least 121 cases of Measles have been documented in recent weeks. Considering that measles is a vaccine preventable disease there has been considerable outcry from the public as to how this was allowed to happen. Why were so many people not vaccinated? 

The outcry over why people were not vaccinated is more recent. Over the last decade there has been a growing number of people who are choosing to not vaccinate. These are not only people who have religious objections but, also people who believe that vaccination is potentially unsafe. The most famous of these anti-vaxxers is Jenny McCarthy. She is famous for arguing that vaccines can cause autism. 

Of course most of these types of arguments are based heavily on a now discredited New England Journal of Medicine article that drew a false connection between vaccination and autism. There is an overwhelming amount of scientific literature that demonstrates that vaccines are not only successful but, they are also safe for most people. Though this scientific evidence does not seem to matter to anti-vaxxers.

However, these individuals cannot simply be misunderstanding the literature. Their behavior cannot simply be explained as scientific know-nothing-ness of fundamentalists. The anti-vaxx movement has significant support among the educated, wealthier segments of society. Therefore, the behavior of these anti-vaxxers may be explained by their mistrust of the traditional institutions that guide public health as opposed to a general misunderstanding of the science behind vaccines.

Over the past couple of weeks there have been countless debates in all media outlets over how to tackle the problem of non-vaccinated individuals. Generally, the supporters of vaccination will repeat similar talking points highlighting the misunderstanding of the science by anti-vaxxers and ultimately endorsing policy change that would force everyone to get vaccinated. However, this approach may not be as successful as advertised. 

To clarify, government mandated vaccination has worked (in general). This does not mean that it will always work. Especially, when the group that is being targeted for intervention has a mistrust of the government. Furthermore, these individuals will always have the option to claim religious objection to vaccination (regardless of their true beliefs) as a final form of resistance to government mandated vaccination.

The solution to the problem is health promotion and community outreach. This would involve media campaigns and small town halls at the community level to help convince and, gain the trust of the anti-vaxxers. Simply presenting the data and highlighting the obvious benefits is not enough, as evidenced by the current dilemma. The health promotion and community outreach based approach to advance behavior change has worked. Take the example of smoking. Smoking is a highly additive activity. While the science explaining it deleterious effects on the human body has been widely published since the 1970s, it was not the science alone that led to behavior change. A long term, concerted health promotion and community outreach effort over the last 40 years has changed the United States from a country where smoking was ubiquitous to one where many places are smoke free.

Simply highlighting the research that supports vaccination will not be enough to convince anti-vaxxers. Data by itself does not convince people, people convince people. Health promotion and community outreach may take more time to solve the problem but, it is the more permanent solution.                               

The Gamification of Smoking

Smoking is the most common way that people get their nicotine. Smoking is also fairly straight forward. All you needed is a cigarette and a way to light it.

With the advent of e-cigarettes this is no longer the case. You now need a vape pen (the electronic cigarette device), a long lasting battery and, the vape juice (the flavored liquid that contains the nicotine). This is the short list for those who are just starting out. As individuals become more "experienced" vapers (people who use e-cigarettes) the possible modifications that they can apply to the vape pens and vape juice are almost endless.

With these modifications, vapers can perform a variety of "tricks" with the types of vapor clouds they blow. Along with the nicotine in the vape juice, another common ingredient is propylene gylcol. The latter is also used in fog machines and, it is this quality that helps vapers to perform tricks with their clouds of smoke.

One of these tricks is called "The Dragon." Here the vaper exhales clouds of smoke from both ends of the lips and from the nostrils giving the appearance of a dragon breathing fire. This is just one example the types of tricks that can be performed. The Tornado, The Ghost, The Atomic Bomb, The French Inhale, Bubbles, The O, and the list of possible tricks continues.

The variety of the tricks and, the ability with which to perform or modify them, has led to development of competition among experienced vapers as to who is better. Vaping is not simply different from smoking because of technical or scientific reasons. The more you vape the more it can become like a game. Who can blow the better clouds?    

The combination of nicotine and the gamification of the manner in which it is inhaled is a very additive combination. With smoking the main addition was caused by the nicotine. However, with vaping there is the added component of competition and the attention that comes though it from social media. Outlets like YouTube, Instagram, and Facebook are filled with videos of vapers demonstrating their prowess. With smoking, cigarette companies needed Marlboro men to advertise and promote the product. However, with vaping every user has the potential to be a brand ambassador.

Vaping may not simply be replacing smoking as a source of nicotine. It is a combination of nicotine and the competition for views , followers, and likes. With vaping, the true addiction may not be the nicotine but the craving of attention.