Spring 2016 Frontlines

Does Cancer Risk Run in the Family?

Screen Shot 2016-07-12 at 10.44.20 AMA large new study of twins finds that if one twin sibling is diagnosed with cancer, the other has a greater-than-average risk of developing cancer. This excess familial risk was seen for almost all of the 23 types of cancer studied, including common malignancies such as breast and prostate cancer but also more rare cancers such as testicular, head and neck, melanoma, ovarian, and stomach. The study, led by researchers at Harvard Chan School, the University of Southern Denmark, and the University of Helsinki, is the first to provide family risk estimates for these and other, rarer cancers. The study also showed for the first time that in twin pairs where both developed cancer, each twin often developed a different type of cancer—suggesting that, in some families, there is a shared increased risk of any type of malignancy.

Health Care Consumers Need More Than “Skin in the Game”

Consumers with high-deductible health plans do not appear to be more motivated to shop around for less-expensive medical care than those with lower-deductible plans, according to a study led by Anna Sinaiko, research scientist in the Department of Health Policy and Management.

Researchers had assumed that consumers paying more of their own money for health care—or having “skin in the game,” as the authors described it—would shop around more than consumers with more generous health insurance. But the authors’ online survey of about 2,000 adults with either high-deductible or lower-deductible health plans found only about 10 percent of respondents in each group reported considering other doctors the last time they purchased medical care. Only about 4 percent compared costs. The authors called for better tools to help consumers find information and efforts to engage consumers in shopping for care.

“Kangaroo Care” May Give Newborns Healthy Start

Screen Shot 2016-07-12 at 10.46.40 AMContinuous skin-to-skin contact between newborns and their mothers during the first days of life may reduce mortality among low-birth-weight babies by more than one-third, compared with conventional care, according to a new finding by researchers from Harvard Chan and Boston Children’s Hospital. Their meta-analysis combined studies that examined the effect of “kangaroo mother care” (KMC)—which is continuous skin-to-skin care typically practiced with exclusive breastfeeding—on newborn health outcomes. The most dramatic reduction in mortality rates was among low-birth-weight or preterm babies. Heavier or full-term babies also experienced beneficial effects on breathing, temperature regulation, and pain tolerance. Senior author Grace Chan, an instructor at Harvard Chan School and a faculty member at Boston Children’s Hospital, notes that while KMC is particularly useful in caring for babies born where medical resources are limited, “developed and developing countries are moving to ‘normalize’ KMC or skin-to-skin as a beneficial practice for all newborns and mothers.”

Fighting Food Deserts Doesn’t Reduce Unhealthy Eating

Policymakers from the White House to the World Health Organization have made eliminating “food deserts”—urban and rural low-income areas lacking access to affordable healthy food—a priority. But is that the best way to help people eat healthier? Researchers from Harvard Chan and Harvard Medical School (HMS) say perhaps not. In an editorial published in PLOS Medicine on December 8, 2015, SV Subramanian, professor of population health and geography at Harvard Chan, and Jason Block, assistant professor of population medicine at HMS, argue there is little evidence that increasing access to food improves dietary quality and reduces obesity. They note that creating incentives for placing supermarkets and grocery stores in food deserts might have other downstream benefits, such as economic development—but to improve diets, policymakers should prioritize education initiatives, changes in food assistance programs, and taxing unhealthy food.

Making Starvation Unfashionable

Screen Shot 2016-07-12 at 10.49.16 AMProhibiting dangerously thin runway models from participating in fashion showsor photo shoots would go a long way toward preventing serious health problems among young women—including anorexia nervosa and death from starvation—according to experts from Harvard Chan.

In an editorial published December 21, 2015, in the American Journal of Public Health, S. Bryn Austin, director of the School’s Strategic Training Initiative for the Prevention of Eating Disorders (STRIPED) and professor in the Department of Social and Behavioral Sciences, and Katherine Record, also with STRIPED and an instructor in health policy and management, call for the U.S. Occupational Safety and Health Administration to set regulations that would prohibit the hiring of models below a given body mass index, such as 18. The authors note that if the U.S. would join with France, which recently banned excessively thin models, it “would shake the fashion industry” and motivate designers to promote healthier models.

A Call To Count Police Killings, Police Deaths

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Counting the number of law enforcement–related deaths each year in the U.S. would provide crucial public health information that could help prevent future deaths, according to a new study from Harvard Chan. The authors propose that these deaths—which include people killed by police, as well as police killed in the line of duty—be tabulated in the “notifiable conditions” reported to the U.S. Centers for Disease Control and Prevention by public health and medical professionals and published in weekly updates. Lead author Nancy Krieger, professor of social epidemiology, says, “It is time to bring a public health perspective to this long-standing and terrible problem, from a standpoint that emphasizes prevention and health equity as opposed to treating these data as if they solely belong to the police and are a matter of criminal justice only.”

Short on Time, Short on Nutrition

Students with less than 20 minutes to eat school lunches consume significantly less of their entrées, milk, and vegetables than those who aren’t as rushed, according to researchers from Harvard Chan.

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Their recent study looked at the lunchroom habits of 1,001 elementary and middle-school students in a low-income urban school district in Massachusetts. As part of a collaboration with the nonprofit Project Bread, the researchers analyzed the students’ food selection and consumption by monitoring what was left on their plates at the end of the lunch period. They found that waiting in serving lines or arriving late to lunch sometimes left children in the study with as little as 10 minutes to actually sit and eat. While not all schools may be able to extend their lunch periods, the authors note, schools could develop strategies to move kids more quickly through lunch lines, such as by adding more serving lines or setting up automated checkout systems.

Global Burden of Mental Illness Underestimated

Screen Shot 2016-07-12 at 10.56.54 AMThe disability and mortality that result from mental illness around the world are underestimated by more than a third, according to researchers from Harvard Chan School and King’s College London. They estimate that mental illness accounts for 32.4 percent of years lived with disability (YLDs) and 13 percent of disability-adjusted life years (DALYs)—a measure of years of healthy life lost due to ill health, disability, or early death. Previous estimates put the global burden of mental illness at 21.2 percent of YLDs and 7.1 percent of DALYs, but the authors argue that mental illness has been inaccurately measured and categorized in the past. Suicide and other forms of self-harm, for instance, were previously categorized as “injuries.” According to coauthor Daniel Vigo, a psychiatrist and a Centennial Fellow in the School’s doctor of public health program, the problem of underestimation is compounded by stigma and leads to low funding of services for mentally ill people, particularly in low- and middle-income countries and underserved areas.