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.

All Quite on the Blogging Front

I apologize for the absence. The holidays always make it difficult to write but I promise to be more steady in the weeks to come. Stay tuned!

The Game Plan in Iraq

Regardless of how much worse foreign policy and security pundits think the situation in Iraq is going to get, there is no denying the country is on the verge of a religious civil war. The Islamic State in Iraq and the Levant (ISIL) is now claiming control of large parts of northern Iraq. They subscribe to a very radical form of Islam, and disturbingly for the Shia dominated government in Baghdad they are fiercely anti-Shia. The ISIL have stated unequivocally that they are coming to Baghdad. Even though the recent successes of the ISIL on the battlefield seem to paint a gloomy picture for the future of Iraq, the Iraqi government may still have options.

Due to the strong Shia influence over the new Iraqi government, Iraq’s ties with Iran have improved from the days of Saddam. There are already reports of potential for military cooperation between Iraq and Iran. That is not to say that this would be a great option. There is still a significant amount of distrust between the two governments, and Iran could try and use the opportunity to increase their influence in the region. Rather than help Iraq, they could simply let the government fall and try and do what Putin tried to do in eastern Ukraine, with the Shia dominated parts of Iraq near the Iranian border. With the Iraqi government and armed forces in disarray it is a unique opportunity for Iran to move into Iraq. They could claim that they are intervening to protect their Shia brothers and sisters (as well as a variety of holy Shia shrines). If the situation on the ground in Iraq continues to worsen then this may not be far from the truth. The Shia dominated parts of Iraq may look to Iran for assistance, especially as more Shia Iraqis refugees flee toward Iran. 

However, Iran is not scheming in a vacuum. The other major power in Iraq is the Kurds. They have not been sitting idle while the ISIL continues its movement toward Baghdad. Accounts from the area of Kirkuk, a strategic northern city in an oil rich region, indicate that the Kurds have taken control of the city. The Kurds have wanted to control the city for a long time, and they have taken advantage of the current instability to make their move. Normally, this type of action by the Kurds would not go unchallenged. However, due to the more imminent threat posed by the ISIL, and the fact that the Iraqi government is in desperate need of allies with boots on the ground, their rising influence may well go unchallenged for the time being. As with Iran, the Kurds have their own agenda. They too may be willing to let the Iraqi government fall, and use this as an opportunity to try and create a sovereign Kurdish state. Considering that their recent actions have not been stymied by Turkey and their other traditional rivals in the area, this may be exactly the opportunity that they have been waiting for.

In this maelstrom of potential strategies, one wonders what the United States will do. President Obama has made it clear that he will not send additional troops on the ground in Iraq. This statement from the President will most likely embolden the other players in the arena to act since they do not have to worry about another U.S. ground based intervention in Iraq. The United States still has options to strike from air and sea to try and slow the advance of the ISIL. The hope is that this will buy time for the Iraqi army to regroup and eventually retake lost ground (with weapons systems supplied by the United States). The problem with the air and sea strike approach is that it depends on the Iraqi military to get its act together. Considering the reports coming out of northern Iraq of discarded Iraqi military uniforms on the road sides ahead of the ISIL advance, the chances of that happening do not look good. Furthermore, a weaker ISIL also helps the Kurds as much as it helps the Iraqi government since they will also have a weaker rival in the ISIL. The benefit that may come from air and sea strikes on the ISIL is that it will let Iran know that the United States is still involved in Iraq, and that an intervention by Iran in Iraq would not go unchallenged.

Based on the options that the Iraqi government has, the situation on the ground in Iraq, and the ambitions of the other major powers in the area, there is a real possibility that the country may splinter. Whether that means a three way split between the ISIL, the current Iraqi government, and a newly formed Kurdish nation, or something else, is anyone’s guess. If the situation in Iraq does not stabilize, and the United States does not act effectively, our Middle Eastern allies (and rivals) may really start to believe that we have pivoted to Asia.

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