Asthma I: Hamilton, Costa Rica and Running

I’ve always had this weird relationship with asthma since it comes with the territory for us East Hamilton folk. Living the first 8 years of my childhood nestled in between a garbage incinerator, a steel mill, the QEW and, Highway 20, my proneness to wheezing was set in stone.

Me and Stelco, BFF's

Me and Stelco, BFF’s

Luckily, moving to the escarpment later in my childhood helped me to just “grow out” of my asthma, partly because I simply refused to use my inhaler (try looking cool running cross-country with an inhaler taped to your hand) but largely because I escaped the smog of my lovely city. For the most part, my experience with asthma had pretty much fizzled out after I turned 13.

Fast forward to this exact day 8 months ago. I had just finished a 10km run in downtown Heredia, Costa Rica during 5:00pm rush hour. A few days prior I was doing the same thing in the hazy, 45°C swimable soup of humidity that is Hamilton in July.

The outcomes of both runs on my body were stark. In Hamilton I was just reduced to a sweaty hot mess, standard fare. But running in Heredia did something exceptional to me. Aside from humbling my underestimation of altitude, It turned my voice-which is already quite raspy to begin with-into an unnatural phlegmy husk. It was incredible because for the first time in a while, I was reminded of my asthma.

Running route in downtown Heredia

Running route in downtown Heredia

Later in my time in Costa Rica, I got to work with a civil society located in this sort of  rural-starting-to-urbanize farming community in the mountains called Copey. Here I met this awesome little girl named Katí, who to my surprise, had acute asthma. Now this posed a problem for me because I had always thought of asthma as an urban epidemic. Copey is generally devoid of any substantial urban activity at the moment, so for me it was hard to imagine what other factors could contribute to giving this young girl asthma in a rural context. I wanted to know if kids like her were getting asthma for the same reason I had asthma.

From what I know, asthma has generally been associated (no concrete causal links) with urbanization and socio-economic status. The global burden of disease has historically been on Western European and English-speaking nations but asthma prevalence rates among these nations have plateaued. The burden of disease is now starting to shift to Low-middle income countries like Costa Rica. However, these are links that speak for urbanized environments. Is it correct to assume that these links can be made to rural areas that are starting to urbanize (like Copey)?

It’s a fair assumption.

An interesting study (Rodriguez et al., 2011) of rural Ecuadorian communities showed that there is a significant relationship between childhood asthma, socio-economic status (parental education, income, cooking fuel, house building material and owning a vehicle) and lifestyle (sedentary activities, fast-food consumption, pet ownership and migration habits). So as far as I can tell, it seems that asthma cases come about when people do urban things in urban settings. In my experience, I would consider socio-economic status and lifestyle indicators as appropriate reasons to explain my asthma and probably Kati’s as well.

However, these are still generalizations since indicators tend to be kind of thin on the substance side. A study like the one above only answers the “what” part of the story but, the International Development student in me is more concerned about the “how” and “who”. These are aspects I’ll take a look at in another post.

References

Rodriguez, A., Vaca, M., Oviedo, G., Erazo, S., Chico, M. E., Teles, C., … & Cooper, P. J. (2011). Urbanisation is associated with prevalence of childhood asthma in diverse, small rural communities in Ecuador. Thorax, 66(12), 1043-1050.

 

 

 

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Moral Dillema, Violence, and Civil War

I’ve always thought my views on violence were firm. I tend to believe that any sort of violent response means that you immediately lose the battle of ideas, that violence becomes the only solution because you cannot convince someone about your views based on the merit of your own words. Simply put, violence is unjustifiable.

I like to think that I have some moral superiority when I say that I detest violence and give my reasons why. But I feel that I can only do so because I’ve never been in any real danger, I’ve never had to test this aspect of my morality. So I’m a hypocrite when I say that given certain circumstances, I think that violence is a perfectly justifiable response.

I often talk to my mom about her life in El Salvador, especially in the 1980’s where she was a university student during the height of her country’s civil war between its right-wing dictatorship (oligarchs, military and US government) and its guerrillas (leftist intellectuals, peasantry and Communist governments).

Her accounts always give me chills since it is a story of a life in constant fear and where her best friends and peers “disappear”. In Latin America, disappearing is a fate much worse than death. But of course, my mom ended up escaping the civil war and found asylum in Canada near the end of the decade. Yet, I can’t help but think that if I were in her position, as I am now (a 21 year old student), I might have chosen a different path. I won’t mince my words, I absolutely would have stayed and fought alongside guerrilla forces despite knowing full well who they were backed by.

I can’t help but reiterate my detest of violence, especially its destructiveness when it becomes manifested through war. The thought of people organizing themselves with the intent to slaughter each other just boggles me. Yet, I can’t help myself in feeling that when democratic channels fail, especially for the most marginalized in society, what hope is there for non-violent means to achieve change? When I look at the country my mom was living in, I have complete empathy for a repressed population who started responding in a language best understood by a military dictatorship.

El Salvador needed 70 000 lives over 12 years to break its political inertia and reach a new state of affairs with the 1992 Chapultepec Peace Accords. I feel kind of dirty for saying this but, I’m adamant that conclusion would have never come to fruition had government opponents never decided to use violence means.

Broken Windows, Band-Aids and Siths

“If my books appear to a reader to be oversimplified, then you shouldn’t read them: you’re not the audience!”.

Precisely.

Those around me know very well my contempt for Gladwell’s The Tipping Point. Ever since reading the book I’ve had a long time to mull over my dissatisfaction.  I’ll be honest and say that  before this past week, I never knew who Malcolm Gladwell was. I’m not really a viewer of TED Talks so that’s probably why. But now because that’s been taken away from me, I can no longer revel in my own ignorance.

For you brave souls who actually read this…getcha popcorn ready.

Now, it’s not so much that I perceived the concepts of The Broken Windows Theory and Band-Aid solutions as counter-intuitive or “radical” as Gladwell would say, far from it. What irked me was how shoddy Gladwell jammed concepts like Broken Window’s Theory and his particular notion of context to fit his narrative that small changes can make a big difference.

My criticisms aren’t new. A few Google searches and I quickly learned that Gladwell has long been scrutinized for his loosey-goosey extrapolations from behavioural studies in every single one of his books since The Tipping Point. Christopher Chabris’s breakdown of Gladwell’s latest book pretty much summarizes major criticisms with his work.

I’ve read enough academic journals to know that someone who says that “they know the know the best way” (Gladwell, 2000, p.60) to frame a concept raises a major red-flag. Take The Law of the Few for instance. Chabris best challenged The Law of the Few stating, “To say something is a law is to say that it applies with (near) universality and can be used to predict, in advance, with a fair degree of certainty, what will happen in a situation”. It gives a loaded impression that these concepts in behavioural sciences are enduring, the closest thing to an absolute (A wise Jedi once said “Only a Sith deals in absolutes”, which in it of itself is an absolute statement. I still love the quote however).

Absolutes bring me to Broken Windows Theory. I’ll be honest with the hindsight bias on the explanation for New York City’s crime drop. I’ve had prior knowledge of several analyses related to Broken Windows after The Tipping Point was written, and long before I’ve ever read the book concerning the conflicting evidence surrounding the New York City case study.

I remember reading Freakonomics back in 2008 that challenged Broken Windows Theory by suggesting that the policing strategy was a confounding variable in New York City’s crime drop in the 90’s. The authors (Levitt and Dubner) explain that: crime in New York City was already on its way down well before Giuliani and Bratton became involved; the NYPD police force grew by 45% between 1991-2001 (which is positively correlated with a decrease crime); the Roe v. Wade decision in the 1970’s where unwanted children susceptible to crime were not being born; and the fact crime decreased nationwide in the US during the 1990’s, not just in New York.

Did Broken Windows play a part in New York City’s dramatic crime drop? It’s perfectly plausible. Was it the silver bullet? We can’t say because nobody knows for sure. One study on Broken Windows in New York between 1989-1998 concluded that there was no support for a disorder-crime relationship or that this strategy was even the optimal use of scarce law enforcement resources. Another study, in the Netherlands, indicated that “Signs of inappropriate behavior like graffiti or broken windows lead to other inappropriate behaviour”. The take-away message from these heavily cited studies is that there can be more than one explanation.

And that’s part of my beef. To continue to push, as Gladwell has done, that policing Broken Windows was the clear cause in explaining New York City’s crime drop is a little much. It’s intriguing that Broken Window’s Theory may have contributed to crime reduction.  The case in the Netherlands demonstrates that there is validity in principles of the Theory. But it’s certainly not causal. I see it as indicative of what Gladwell is willing to do to fit his narrative.

 “The Power of Context says you don’t have to solve the big problems to solve crime” (Gladwell, 2000, p.151)

(Come again?)

Now It’s not to say that you shouldn’t consider unorthodox variables or as Gladwell (2000, p.150) calls them, “the little things”. Framing problems as having non-linear dimensions helps broaden the scope of assessing epidemics and can very will lead to novel solutions; that’s the point of epidemiology. But why does that mean social determinants like race, poverty, unemployment and, institutional neglect ought to be overlooked in favour of counter-intuitive variables like graffiti and fare-beaters?

Gladwell says (2000, p.150), “…the Power of Context says what really matters is the little things…You can prevent crimes just by scrubbing of graffiti and arresting fare-beaters”. Here, it’s clear to me that his version of context is objective, that something like disorder and crime are elements that can be clearly defined and separated. He reduces a social problem in a way that makes his “little things” (disorder) an independent variable and crime a dependent variable. Gladwell is  asking us to accept  that socio-structural inequities really don’t matter.

So why does that mean social determinants ought to be overlooked in favour of Gladwell’s counter-intuitive variables? The answer, as I see it, is that it’s the only way that Broken Windows Theory and by extent, Band-Aid solutions as advocated by Gladwell, make sense as policy tools. Since Broken Windows is contingent on tackling disorder, it would be reasonable to focus on decreasing disorder. If the reader accepts Gladwell’s distinction of variables, then OF COURSE (some might say Claro Que Si) a Band-Aid solution like Broken Windows “is…the best kind of solution” (Gladwell, 2000, p.258).

But here’s the thing about disorder: it’s been shown to carry an implicit bias. Disorder might be less about how we perceive our environment but rather, the subject matter Gladwell deflected attention from. When we speak of disorder, race and economic circumstances have been shown to matter more. A study of 500 block groups in Chicago showed that when the concentration of minority groups and poverty increases, residents of all races perceive heightened disorder, regardless of observed disorder (i.e broken windows).

For the case of New York, here’s a primer. There is plenty of evidence to suggest that the policing of Broken Windows in New York City has been a person-centered activity, not an environment-centered one. Davies and Fagan (2000) demonstrate with empirical evidence that “[Broken Windows] policing is not about disorderly places…but about policing poor people in poor places”. This is because they found that that the racial and economic composition of neighbourhoods could predict race and crime specific stops.

Gladwell completely ignored this stark incongruence of the application of Broken Windows from theory to practice in The Tipping Point and really establishes just how selective his narrative is. It’s one thing to ask us to reframe the way we think about the world, but it’s also another thing to do so in a way that blocks out the things that appear to have such a gripping influence in how we already look at the world to begin with. Treating disorder as an independent variable relies on how much you’re willing to bend you’re definition of context.

Step 1. Tinker
Step 2. ???
Step 3. Profit

Everything in this book boils down to the Band-Aid solution, the Deus ex Machina of big problem-solving as advocated by Gladwell. It has everything that you could ever want: inexpensiveness, convenience, versatility, efficiency, a short-cut. It’s perfect in every single way, just look at all the confirming examples. There are no bounds to its applicability. It’s a technocrat’s wet dream.

I think it’s here where most of my problem with The Tipping Point sort of pools together. The whole crux of the book is to advocate that social change can be achieved by simply tinkering. We are told that by tinkering,  “people can radically transform their behaviours or beliefs” (Gladwell, p. 258). But this message alone isn’t enough. Gladwell provides us with such a high degree of personal agency because according to him (2000, p.167) “Environmental Tipping Points are things that we can change”. So not only does he tell us the exact parameters on how to look at the world, we are also given his permission to think that way.

So I mean, what sort of change can you actually expect if you frame social problems as Gladwell does?

His idea of change is superficial if his deliberation of Broken Windows Theory is any indication. If “Broken Windows theory and the Power of Context are one and the same” (Gladwell 2000, p.146) , then change is literally superficial because we’re only looking for solutions that change the surface of the problem, not the root.

It’s so easy to have Band-Aid solutions if we remove socio-structural inequities environmental determinants from the conversation and pretend that they don’t exist. Unequal power dynamics, history, spatial segregation, perceptional biases? No. That stuff is too hard. But what about graffiti?

It reminds me a lot about my grievance with how Sustainable Development has often been conceptualized for social change. It’s treated a lot like a Band-Aid solution. Like the Tipping Point, sustainable development creates the impression that only tweaks need to be made for significant change, yet it does nothing to challenge the status quo that has brought upon the problems that require change in the first place.

In my opinion, Gladwell’s way of framing is most appropriate to keep things business-as-usual. I can’t see anything radical or transformative about his ideas.

I’m not trying to be malicious. Gladwell should be commended for bringing behvioural sciences into mainstream discussion where his academic opposites have failed. I can’t imagine how anyone could make these studies palatable to the masses.

But how the hell am I supposed to take someone like him seriously when he speaks well beyond empirical data? Why should I take his word that Band-Aid solutions have merit?

I understand that he posits himself as story-teller and not an academic. However, that’s a poor excuse to give him any sort of pardon on how he goes about presenting empirical evidence considering how large an audience he has. What he’s presenting are intriguing reflections but some might take it as causal evidence of how the world actually works and fool-proof prescriptions to solve its problems. I seriously hope that’s not the case.

Get in Line Russia

Excerpts of US Secretary of State John Kerry taken from Meet the Press:

“You just don’t in the 21st century behave in 19th century fashion by invading another country on completely trumped up pre-text,”

“The hope of the United States and everybody in the world is not to see this escalate into a military confrontation. That will not serve the world well, and I think everybody understands that.”

“We want a peaceful resolution through the normal processes of international relations.”

“If Russia wants to be a G8 country, it needs to behave like a G8 country,”

 
The irony hurts so much I could die, but he’s still right. Man, Sochi seems like it never even happened at all.

The Pipeline Explosion That Almost Wasn’t But Was

An investigation from the CBC has revealed that the National Energy Board (NEB) buried this report on a rupture caused by corrosion in TransCanada’s Peace River Mainline (PRML) pipeline located in Northern Alberta. On July 20, 2009, the PRML ruptured, shooting up 50-m flames in the air while at the same time releasing 1.45 billion cubic metres worth of natural gas. The result was the 2-hectare scarring of a woodlot. Sorry Lorax.

The NEB completed an early draft of their report of this incident in January 2011 which cited inadequate field investigation, ineffective operational control and inadequate inspection on the part of TransCanada; government-speak for incompetence. If you’ve never heard of what has been billed as one of largest pipeline ruptures of the past decade, there’s a reason for that. This report wasn’t released until this January 2014 when the CBC filed an access-to-information request; three years after the initial report was completed, five years after the original incident. The request had to be made after the CBC asked for the report last October on four separate occasions, yet every time, the NEB refused to release the report.

Now why is that? The NEB claims that this three year lag in releasing the report was due to “an administrative error when an employee left without transferring the file over”. Or in real-speak, they tried to cover it up. But here is where we can pull together all the juicy parts because I love it when a story comes together. We have to remember what was going on during the completion of the report in January of 2011. This was the same time when the Canadian ambassador to the United States was lobbying the U.S. State Department for a presidential permit to approve the construction of the pipeline into the United States. Not exactly the time that you want to explain why Independence Day was happening in Alberta.

Fast forward to last week where the US State Department produced a crucial report that found no major environmental objections to the construction of the Keystone XL. Here we get a clear understanding as to why the CBC’s multiple requests for the NEB’s pipeline report in October 2013 were denied and why we are just now hearing about this major pipeline rupture that happened 5 years ago. Turns out that all that lobbying paid off and that TransCanada has just pulled off the greatest comeback since Lazarus. What was once considered to be a mega-project in limbo is now all but assured to get the green-light after the already initiated 90-day environmental assessment comes to a “recommendation”

We can already see the political machine start to flurry around the Keystone XL as it has just been reported that part of the House GOP playbook in the upcoming debt-limit negotiations with the Democrats may very well include trying to get Obama to approve the pipeline in return for a debt-limit extension. But I mean this is all theatre and political positioning. TransCanada has already completed the Southern-leg of Keystone under Obama’s watch, much to the ire of his liberal-environmentalist supporters. My guess is that if Republicans were to make him that kind of offer, it would make for a convenient in for Obama to say yes to the construction of Keystone XL.

On the domestic side here in Canada, the jury is still out on who exactly hid the report for three years. This story has that familiar feel corruption and dirtiness that has plagued the PMO for quite some time. But then again, who can blame the Conservatives? The Keystone XL is a $6 billion dollar beast of project and is part of the trio of proposed pipelines (Northern Gateway, Keystone XL and the Trans Mountain Expansion) which are estimated to rake in $1.298 billion for the Canadian economy. There is no chance in hell that they’re going to lose out on this cash cow. Whether you’re an environmentalist, a proponent of sustainable development or someone who lives on the pipeline route, prepared to have your heart BROKEN come May.

Spoiler Alert: No