(Roughly) Daily

Posts Tagged ‘public health

“It is what it is”*…

COVID-19 deaths in the U.S. have topped 700,000, which means that more Americans have died in the pandemic than died in every foreign conflict the U.S. has ever fought (combined combat deaths in all U.S foreign wars are estimated at 659,267).

This graphic is from r/dataisbeautiful.

Two things to note:

  1. Deaths in the American Civil War were equal or higher (they’re estimated to have been 620,000 and 750,000 soldiers dead, along with an undetermined number of civilian casualties).
  2. On a death-per-100,000-population basis, COVID-19 deaths are at roughly 211 per 100,000. That’s materially more than deaths in any U.S. foreign war except World War II (which had a death toll of 307 per 100,000). See here and here for the underlying data.

then-President Donald Trump, on COVID deaths

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As we mourn, we might recall that it was on this date in 1945 that Desmond Doss received the U.S. Medal of Honor. A conscientious objector serving as a U.S. Army medic, he saved 75 men during the Battle of Okinawa during World War II. (Prior to that, he had twice been awarded the Bronze Star for heroism in Guam and the Philippines.) He was the only conscientious objector to receive the Medal of Honor for his actions during the war; his story has been told in several books, a documentary (The Conscientious Objector), and the 2016 Oscar-winning film Hacksaw Ridge.

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Written by (Roughly) Daily

October 12, 2021 at 1:00 am

“When the graphs were finished, the relations were obvious at once”*…

We can only understand what we can “see”…

… this long-forgotten, hand-drawn infographic from the 1840s… known as a “life table,” was created by William Farr, a doctor and statistician who, for most of the Victorian era, oversaw the collection of public health statistics in England and Wales… it’s a triptych documenting the death rates by age in three key population groups: metropolitan London, industrial Liverpool, and rural Surrey.

With these visualizations, Farr was making a definitive contribution to an urgent debate from the period: were these new industrial cities causing people to die at a higher rate? In some ways, with hindsight, you can think of this as one of the most crucial questions for the entire world at that moment. The Victorians didn’t realize it at the time, but the globe was about to go from less than five percent of its population living in cities to more than fifty percent in just about a century and a half. If these new cities were going to be killing machines, we probably needed to figure that out.

It’s hard to imagine just how confusing it was to live through the transition to industrial urbanism as it was happening for the first time. Nobody really had a full handle on the magnitude of the shift and its vast unintended consequences. This was particularly true of public health. There was an intuitive feeling that people were dying at higher rates than they had in the countryside, but it was very hard even for the experts to determine the magnitude of the threat. Everyone was living under the spell of anecdote and availability bias. Seeing the situation from the birds-eye view of public health data was almost impossible…

The images Farr created told a terrifying and unequivocal story: density kills. In Surrey, the increase of mortality after birth is a gentle slope upward, a dune rising out of the waterline. The spike in Liverpool, by comparison, looks more like the cliffs of Dover. That steep ascent condensed thousands of individual tragedies into one vivid and scandalous image: in industrial Liverpool, more than half of all children born were dead before their fifteenth birthday.

The mean age of death was just as shocking: the countryfolk were enjoying life expectancies close to fifty, likely making them some of the longest-lived people on the planet in 1840. The national average was forty-one. London was thirty-five. But Liverpool—a city that had undergone staggering explosions in population density, thanks to industrialization—was the true shocker. The average Liverpudlian died at the age of twenty-five, one of the lowest life expectancies ever recorded in that large a human population.

There’s a natural inclination to think about innovation in human health as a procession of material objects: vaccines, antibiotics, pacemakers. But Farr’s life tables are a reminder that new ways of perceiving the problems we face, new ways of seeing the underlying data, are the foundations on which we build those other, more tangible interventions. Today cities reliably see life expectancies higher than rural areas—a development that would have seemed miraculous to William Farr, tabulating the data in the early 1840s. In a real sense, Farr laid the groundwork for that historic reversal: you couldn’t start to tackle the problem of how to make industrial cities safer until you had first determined that the threat was real.

Why the most important health innovations sometimes come from new ways of seeing: “The Obscure Hand-Drawn Infographic That Changed The Way We Think About Cities,” from Steven Johnson (@stevenbjohnson). More in his book, Extra Life, and in episode 3 of the PBS series based on it.

* J. C. R. Licklider

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As we investigate infographics, we might send carefully calculated birthday greetings to Lewis Fry Richardson; he was born on this date in 1881.  A mathematician, physicist, and psychologist, he is best remembered for pioneering the modern mathematical techniques of weather forecasting.  Richardson’s interest in weather led him to propose a scheme for forecasting using differential equations, the method used today, though when he published Weather Prediction by Numerical Process in 1922, suitably fast computing was unavailable.  Indeed, his proof-of-concept– a retrospective “forecast” of the weather on May 20, 1910– took three months to complete by hand. (in fairness, Richardson did the analysis in his free time while serving as an ambulance driver in World War I.)  With the advent of modern computing in the 1950’s, his ideas took hold.  Still the ENIAC (the first real modern computer) took 24 hours to compute a daily forecast.  But as computing got speedier, forecasting became more practical.

Richardson also yoked his forecasting techniques to his pacifist principles, developing a method of “predicting” war.  He is considered (with folks like Quincy Wright and Kenneth Boulding) a father of the scientific analysis of conflict.

And Richardson helped lay the foundations for other fields and innovations:  his work on coastlines and borders was influential on Mandelbrot’s development of fractal geometry; and his method for the detection of icebergs anticipated the development of sonar.

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“Demographics are destiny”*…

And demographics can help us shape our destiny…

The research seemed straightforward: Analyze 2020 death records in Minnesota and, among other things, quantify which deaths were attributable to Covid-19 in various slices of the population — young and old, black and white, people living in advantaged versus disadvantaged neighborhoods.

But when University of Minnesota demographer Elizabeth Wrigley-Field began to dig in, the numbers revealed complex trends.

The records showed that last year more Minnesotans — especially non-whites — died at home than in a typical year, having avoided hospitals because of the pandemic. Such deaths were almost never reported as Covid-related, even though many probably were. The analysis suggested that Covid deaths in minority groups were going underreported.

It’s the sort of intriguing finding that is likely to percolate to the surface more frequently as researchers study Covid-19 from a population — or demographic — perspective.

Soon after the pandemic hit, demographers leaped into action. Today, there are studies afoot to examine a broad swath of inquiry: from questions about life expectancy to whether school closures really averted infections to how a single Covid death affects surviving family members’ physical and mental health. Even the relationship between exercise habits and social-distancing trends in US counties is under scrutiny…

A sample of the findings that could– and surely should– shape the future of public health: “Demographers tackle Covid-19,” from Eryn Brown (@TheErynBrown).

[Via David Kotok]

* Arthur Kemp, Peter Peterson, Bill Campbell, and many others

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As we count on counting, we might recall that it was on this date in 1896 that the U.K. recorded its first automotive fatality. While on a terrace in the grounds of Crystal Palace, London, Mrs. Bridget Driscoll was knocked down by a car owned by the Anglo-French Motor Car (Roger-Benz) Company that was giving demonstration rides to the public, driven by employee Arthur Edsell. It was said that he was talking to the young lady passenger beside him. He had had been driving for only 3 weeks, and had tampered with a belt to cause the car to travel faster than the 4 mph to which it was meant to be limited. After a six-hour inquest, the jury’s verdict was “Accidental Death,” and no prosecution resulted against the driver or the company. The first car-driver crash fatality in Britain occurred in 1898.

Mrs. Driscoll, circled

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Written by (Roughly) Daily

August 17, 2021 at 1:00 am

“God loveth the clean”*…

The history of ordinary things can be fascinating while offering insight into our immediate future. We’ve previously noted how artificial ice and assorted refrigeration/cooling technologies helped change demographics in the American South. Recent news from the Census Bureau confirms this trend as northern states like Michigan and New York lost population while the south, Texas and Florida in particular, gained. But the history of the ordinary can be hidden by ubiquity, tedium, and general disinterest. Unnoticed until they cry out for attention. Today’s Tedium is looking at the history of New York City restaurant inspections and the variety of ways restaurants cope. (And yes, the pandemic has certainly had an impact.)

There is no shortage of great New Yorkers, the people that helped shape the city and its culture. How one measures impact can vary. The wealthy and influential find their names on street signs, convention centers, and airports. A year into the COVID-19 pandemic, however, there is a renewed appreciation for those that helped lay the foundation for the city’s hospitals and medical care. In this regard, there are few New Yorkers greater than Dr. Sigismund Goldwater. 

A graduate of Columbia University and NYU medical school, Dr. Goldwater was a recognized authority in hospital construction. Among the numerous posts he held over a distinguished career included Superintendent at Mount Sinai Hospital, president of the American Conference on Hospital Service, and vice president of the New York Academy of Medicine. In recognition of his career and experience, he was appointed City Commissioner of Hospitals from 1934 to 1940. During his administration, Dr. Goldwater oversaw the construction of 25 new hospital buildings. His Times obituary credits him with adding more than 5,000 hospital beds to city capacity.

While his work in hospital administration and construction helped lay the foundation for New York City as a world-class center for health care, Dr. Goldwater has a legacy a bit more meaningful to modern restaurateurs. In 1914, Mayor John Purroy Mitchel was newly elected and in need of a health commissioner. His first choice, Dr. Goldwater, didn’t really want the job but finally acquiesced on the strong insistence of his predecessor. 

About six months after taking over the role, now Health Commissioner Goldwater announced a couple of general initiatives in public transportation and dining to ensure general cleanliness, pointing out to the Times that, “…the Sanitary Code at present did not call for regular inspection as in the case of bakeries and meat markets.” His solution was to require permits and require commercial restaurants to be inspected on an annual basis.

Public health, especially regarding sanitary food handling practices, had grabbed media attention in the early 20th century in part to Upton Sinclair’s The Jungle. Sinclair, an investigative journalist, went undercover to detail the working conditions in meat packing facilities. His account of rat infested factories and spoiled meat products shipped to consumers provoked outrage. Unfortunately for Sinclair, who was trying to shed light on the conditions of workers, readers were incensed to learn what was in their food. By 1905, the federal government had passed legislation to create what would become the Food and Drug Administration (FDA).

Another unique circumstance that kept food safety in the minds of New Yorkers was the terrible tale of Mary Mallon, better known as Typhoid Mary. A private cook that was also an asymptomatic carrier of typhoid, Mary Mallon became infamous for her condition, the number of people she infected, and her refusal to cooperate with safety guidelines. [See here]

There was another reason for the attention Mary Mallon received, explains Claire Stewart, a chef and hospitality management professor at the New York City College of Technology. “Typhoid was considered a disease of the poor and associated with immigrants and overcrowded tenements,” she said. “Mary Mallon spent a lot of her career cooking for wealthy people, so her bringing typhoid to the upper classes caused a lot of alarm.”

Still, by the time Dr. Goldwater became health commissioner, New York City had yet to regulate restaurants, creating a range of dining experiences and anxiety about the status of any given kitchen.

One concerned citizen wrote to the Times in a letter titled, “We Need Dainty Waiters.”, “In these days of pure food laws and Boards of Health… I would like to ask what assurance, if any, has the public that in our hotels, restaurants, and clubs proper supervision over their employes is exercised so as to insure us a fair degree of cleanliness on the part of those who handle the food we are to eat? This inquiry is prompted by occurrences coming under the personal observation of the writer, showing that employes in so-called high-class hotels, clubs, and restaurants are often guilty of practices which would not be tolerated in our own homes. One large restaurant in this city requires its waiters to pass an inspection by a manicure before they are allowed to handle food for its patrons.”

After Dr. Goldwater noted that other cities had also adopted regular restaurant inspections, and noting the potential for additional revenue via fines and permit fees, the city agreed. Now they just had to get some 15,000 owners and operators to comply. Should be easy, right?…

The wacky and surprising history of NYC restaurant inspections (and by extension, that same system in other cities). That letter grade is a lot more effective than you might think: “The Letter in the Window.” By Andrew Egan, in Ernie Smith’s (@ShortFormErnie) ever-illuminating newsletter Tedium (@readtedium).

* Francis Bacon

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As we wash our hands, we might recall that it was on this date in 1913 that Gideon Sundback was granted a patent on the first modern zipper. While he did well with his invention for several decades, he and his western competitors were overtaken in the mid-20th century by YKK.

Most checked chefs pants still have buttons.

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Written by (Roughly) Daily

April 29, 2021 at 1:01 am

“Let him that would move the world first move himself”*…

In 1930, Indiana Bell, a subsidiary of AT&T, needed a larger building for their headquarters. The problem? The old building needed to stay in operations at all times, providing an essential service to the city. Instead of tearing it down or simply moving to a new building, they decided to move it to a different part of the lot and build on the existing location. Just that.

The massive undertaking began on October 1930. Over the next four weeks, the massive steel and brick building was shifted inch by inch 16 meters south, rotated 90 degrees, and then shifted again by 30 meters west. The work was done with such precision that the building continued to operate during the entire duration of the move. All utility cables and pipes serving the building, including thousand of telephone cables, electric cables, gas pipes, sewer and water pipes had to be lengthened and made flexible to provide continuous service during the move. A movable wooden sidewalk allowed employees and the public to enter and leave the building at any time while the move was in progress. The company did not lose a single day of work nor interrupt their service during the entire period.

Incredibly most of the power needed to move the building was provided by hand-operated jacks while a steam engine also some support. Each time the jacks were pumped, the house moved 3/8th of an inch.

Via Kottke and The Prepared; TotH to @splattne and @mckinleaf

Fun fact: the entire project– including the move– was designed by a leading Indianapolis architect, Kurt Vonnegut Sr., father of the famous novelist (and of the chemist who developed the technique of seeding clouds with silver iodide to produce rain/snow).

Over a month in 1930, the Indiana Bell building was rotated 15 inch/hr– overall, 90°– all while 600 employees still worked there.

* Socrates

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As we change perspective, we might recall that it was on this date in 1915 that Mary Mallon, “Typhoid Mary,” was put in quarantine on North Brother Island, in New York City, where she was isolated until she died in 1938.  She was the first person in the United States identified as an asymptomatic carrier of the pathogen associated with typhoid fever… before which, she inadvertently spread typhoid for years while working as a cook in the New York area.

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Written by (Roughly) Daily

March 26, 2021 at 1:01 am

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