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Putting the Disaster in Natural Disasters. Why Do We Live in Harm's Way?
As extreme weather events seem to be increasing around the world, changes consistent with the kinds of things climate change is predicted to cause, many people are realizing something for the first time. Hundreds of millions of people around the world choose to live in areas prone to severe floods, forest fires, hurricanes, earthquakes, volcanoes. Such violent natural events only become ‘disasters’, in fact, because so many people have chosen to live in harm’s way. Why do people expose themselves to such danger? And how does the psychology of this sort of risk-taking challenge the hazard managers who are responsible for mitigating these perils and keeping people safe?
A central cause of this problem is our misunderstanding of probability. As certain as these events are to occur over the long term, for any given place and any given time earthquakes and tornadoes and floods are low probability events. The chance of the next “Big One” earthquake in southern California – magnitude 7 or greater - is close to 100% sometime in the next 50 years, but it’s only two or three percent for any one of those years. Those low odds of risk in the shorter term, the time frame we care about the most, play right into some serious cognitive limitations that challenge our ability to make intelligent choices about risk.
We pay more attention to, and worry more about, not necessarily the greatest threat, but what is most salient. A risk can be salient because some example of it is in the news - on our radar screen at the moment - or because we have memories of the risk from some particularly emotional or meaningful experiences. Such memories are burned more deeply into our brains, and come to mind more readily and more powerfully, and our brain knows, in essence, that it better pay more attention when such meaningful memories surface. The people who study the suite of mental shortcuts that subconsciously help us turn partial information into our judgments and decisions call this the Availability Heuristic.
Well, rare events are mostly NOT salient. They are rarely on our radar screen, and many who live in potentially dangerous areas have never lived through The Big One earthquake, or a Category 4 or 5 hurricane, or an out-of-control raging forest fire burning down their house. They have no powerful personal emotional experience with these threats, memories that would make such dangers more ‘available’ to their brain, more compelling, more salient. In the absence of that salience, another facet of risk perception psychology takes over; Optimism Bias…the feeling we have about lots of risks all the time…”It won’t happen to me.”
Optimism Bias let’s us do all sorts of risky things that we want to do, from bungee jumping to driving and texting to living in places where we want to live even if those places are dangerous. It lets us buy the house in the beautiful but fire-prone forests of the Colorado mountains, or on the beautiful but hurricane-prone shores of North Carolina. It lets us take the job in LA or San Francisco, where a devastating earthquake in the next 50 years is a near certainty. It helps explain why we live in the lahar zones of volcanoes like Mt. Rainier or Mammoth Mountain California. It even helps explain why we don’t buy insurance against low probability risks. Fewer than 20% of California homeowners in earthquake prone areas have earthquake insurance. The vast majority of people living in areas of America at risk of severe flooding have no flood insurance. Why get insurance for low probability risks, even if they are disastrous, they wonder? After all, “It won’t happen to ME.”
And in truth, it probably won’t. Probably. But that’s a whole additional problem. We assume all sorts of things about probability that are just plain wrong. For example, our judgments of what is likely to happen next are based on way-too-small samples of what has happened before. If you flip a coin and it comes up heads ten times in a row, how will it land on the next flip? Many people think tails MUST be more likely. Nope. The sample is too small.
Gamblers who think this way, lose. But it’s precisely the same gamble people take who live in disaster-prone areas. They think that after deadly tornadoes two years in a row in Moore Oklahoma, or “the 100 year flood” in Missouri in 2011, the odds MUST be lower that it will happen again anytime soon, right? Wrong! Next year’s weather hasn’t gotten that memo yet.
We also have problems with the arithmetic of risk. Which risk is bigger, 1 in a thousand, 1 in a million, or 1 in ten? A widely-cited study found that one person in five couldn’t answer that seemingly simple question correctly (1 in ten is the bigger…most likely…risk). And 80% of the sample had a high school education or better.
So we misunderstand probabilities, and we worry less about less salient rare risks with which we have no powerful first hand experience. As a result, we put ourselves in harm’s way. And it’s getting worse. The losses in money from such choices is increasing dramatically, as populations increase in places where nature gets violent.
These cognitive limitations also make it harder for hazard managers to keep us safe with wise risk mitigation policies. It costs money to reinforce buildings in California, or build safe room shelters in Tornado Alley, but if people aren’t worried enough, they won’t spend it. People don’t want to be told they can’t rebuild their home where the old one blew down in a hurricane or burned down in a forest fire, so they resist intelligent building codes or new more accurate flood maps. They don’t even want to be told they have to pay more for insurance if they choose to live in risky areas, where the rates should be higher, which means the rest of society then has to pay for the recovery when the flood/quake/storm hits.
We get risk right in lots of ways, but our perceptions also cause us to make mistakes, mistakes that can be dangerous, the phenomenon that in my book I call the Risk Perception Gap. We worry about some risks more than the evidence merits, and we don’t worry as much about some as the evidence warns. Natural disasters are an example of not worrying enough, and another example of how the way we perceive and respond to risk is something to worry about all by itself.
The COVID-19 pandemic is making health disparities in the United States crystal clear. It is a clarion call for health care systems to double their efforts in vulnerable communities.
- The COVID-19 pandemic has exacerbated America's health disparities, widening the divide between the haves and have nots.
- Studies show disparities in wealth, race, and online access have disproportionately harmed underserved U.S. communities during the pandemic.
- To begin curing this social aliment, health systems like Northwell Health are establishing relationships of trust in these communities so that the post-COVID world looks different than the pre-COVID one.
COVID-19 deepens U.S. health disparities<p>Communities on the pernicious side of America's health disparities have their unique histories, environments, and social structures. They are spread across the United States, but they all have one thing in common.</p><p>"There is one common divide in American communities, and that is poverty," said <a href="https://www.northwell.edu/about/leadership/debbie-salas-lopez" target="_blank">Debbie Salas-Lopez, MD, MPH</a>, senior vice president of community and population health at Northwell Health. "That is the undercurrent that manifests poor health, poor health outcomes, or poor health prognoses for future wellbeing."</p><p>Social determinants have far-reaching effects on health, and poor communities have unfavorable social determinants. To pick one of many examples, <a href="https://www.npr.org/2020/09/27/913612554/a-crisis-within-a-crisis-food-insecurity-and-covid-19" target="_blank" rel="noopener noreferrer">food insecurity</a> reduces access to quality food, leading to poor health and communal endemics of chronic medical conditions. The U.S. Centers for Disease Control and Prevention has identified some of these conditions, such as obesity and Type 2 diabetes, as increasing the risk of developing a severe case of coronavirus.</p><p>The pandemic didn't create poverty or food insecurity, but it exacerbated both, and the results have been catastrophic. A study published this summer in the <em><a href="https://link.springer.com/article/10.1007/s11606-020-05971-3" target="_blank">Journal of General Internal Medicine</a></em> suggested that "social factors such as income inequality may explain why some parts of the USA are hit harder by the COVID-19 pandemic than others."</p><p>That's not to say better-off families in the U.S. weren't harmed. A <a href="https://voxeu.org/article/poverty-inequality-and-covid-19-us" target="_blank" rel="noopener noreferrer">paper from the Centre for Economic Policy Research</a> noted that families in counties with a higher median income experienced adjustment costs associated with the pandemic—for example, lowering income-earning interactions to align with social distancing policies. However, the paper found that the costs of social distancing were much greater for poorer families, who cannot easily alter their living circumstances, which often include more individuals living in one home and a reliance on mass transit to reach work and grocery stores. They are also disproportionately represented in essential jobs, such as retail, transportation, and health care, where maintaining physical distance can be all but impossible.</p><p>The paper also cited a positive correlation between higher income inequality and higher rates of coronavirus infection. "Our interpretation is that poorer people are less able to protect themselves, which leads them to different choices—they face a steeper trade-off between their health and their economic welfare in the context of the threats posed by COVID-19," the authors wrote.</p><p>"There are so many pandemics that this pandemic has exacerbated," Dr. Salas-Lopez noted.</p><p>One example is the health-wealth gap. The mental stressors of maintaining a low socioeconomic status, especially in the face of extreme affluence, can have a physically degrading impact on health. <a href="https://www.scientificamerican.com/index.cfm/_api/render/file/?method=inline&fileID=123ECD96-EF81-46F6-983D2AE9A45FA354" target="_blank" rel="noopener noreferrer">Writing on this gap</a>, Robert Sapolsky, professor of biology and neurology at Stanford University, notes that socioeconomic stressors can increase blood pressure, reduce insulin response, increase chronic inflammation, and impair the prefrontal cortex and other brain functions through anxiety, depression, and cognitive load. </p><p>"Thus, from the macro level of entire body systems to the micro level of individual chromosomes, poverty finds a way to produce wear and tear," Sapolsky writes. "It is outrageous that if children are born into the wrong family, they will be predisposed toward poor health by the time they start to learn the alphabet."</p>Research on the economic and mental health fallout of COVID-19 is showing two things: That unemployment is hitting <a href="https://www.pewsocialtrends.org/2020/09/24/economic-fallout-from-covid-19-continues-to-hit-lower-income-americans-the-hardest/" target="_blank" rel="noopener noreferrer">low-income and young Americans</a> most during the pandemic, potentially widening the health-wealth gap further; and that the pandemic not only exacerbates mental health stressors, but is doing so at clinically relevant levels. As <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7413844/" target="_blank" rel="noopener noreferrer">the authors of one review</a> wrote, the pandemic's effects on mental health is itself an international public health priority.
Working to close the health gap<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDc5MDk1MS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYxNTYyMzQzMn0.KSFpXH7yHYrfVPtfgcxZqAHHYzCnC2bFxwSrJqBbH4I/img.jpg?width=980" id="b40e2" class="rm-shortcode" data-rm-shortcode-id="1b9035370ab7b02a0dc00758e494412b" data-rm-shortcode-name="rebelmouse-image" />
Northwell Health coronavirus testing center at Greater Springfield Community Church.
Credit: Northwell Health<p>Novel coronavirus may spread and infect indiscriminately, but pre-existing conditions, environmental stressors, and a lack of access to care and resources increase the risk of infection. These social determinants make the pandemic more dangerous, and erode communities' and families' abilities to heal from health crises that pre-date the pandemic.</p><p>How do we eliminate these divides? Dr. Salas-Lopez says the first step is recognition. "We have to open our eyes to see the suffering around us," she said. "Northwell has not shied away from that."</p><p>"We are steadfast in improving health outcomes for our vulnerable and underrepresented communities that have suffered because of the prevalence of chronic disease, a problem that led to the disproportionately higher death rate among African-Americans and Latinos during the COVID-19 pandemic," said Michael Dowling, Northwell's president and CEO. "We are committed to using every tool at our disposal—as a provider of health care, employer, purchaser and investor—to combat disparities and ensure the <a href="https://www.northwell.edu/education-and-resources/community-engagement/center-for-equity-of-care" target="_blank" rel="noopener noreferrer">equity of care</a> that everyone deserves." </p><p>With the need recognized, Dr. Salas-Lopez calls for health care systems to travel upstream and be proactive in those hard-hit communities. This requires health care systems to play a strong role, but not a unilateral one. They must build <a href="https://www.northwell.edu/news/insights/faith-based-leaders-are-the-key-to-improving-community-health" target="_blank" rel="noopener noreferrer">partnerships with leaders in those communities</a> and utilize those to ensure relationships last beyond the current crisis. </p><p>"We must meet with community leaders and talk to them to get their perspective on what they believe the community needs are and should be for the future. Together, we can co-create a plan to measurably improve [community] health and also to be ready for whatever comes next," she said.</p><p>Northwell has built relationships with local faith-based and community organizations in underserved communities of color. Those partnerships enabled Northwell to test more than 65,000 people across the metro New York region. The health system also offered education on coronavirus and precautions to curb its spread.</p><p>These initiatives began the process of building trust—trust that Northwell has counted on to return to these communities to administer flu vaccines to prepare for what experts fear may be a difficult flu season.</p><p>While Northwell has begun building bridges across the divides of the New York area, much will still need to be done to cure U.S. health care overall. There is hope that the COVID pandemic will awaken us to the deep disparities in the US.</p><p>"COVID has changed our world. We have to seize this opportunity, this pandemic, this crisis to do better," Dr. Salas-Lopez said. "Provide better care. Provide better health. Be better partners. Be better community citizens. And treat each other with respect and dignity.</p><p>"We need to find ways to unify this country because we're all human beings. We're all created equal, and we believe that health is one of those important rights."</p>
What’s Eminem doing in Missouri? Kanye West in Georgia? And Wiz Khalifa in, of all places, North Dakota?
This is a mysterious map. Obviously about music, or more precisely musicians. But what’s Eminem doing in Missouri? Kanye West in Georgia? And Wiz Khalifa in, of all places, North Dakota? None of these musicians are from those states! Everyone knows that! Is this map that stupid, or just looking for a fight? Let’s pause a moment and consider our attention spans, shrinking faster than polar ice caps.
Can passenger airships make a triumphantly 'green' comeback?
Large airships were too sensitive to wind gusts and too sluggish to win against aeroplanes. But today, they have a chance to make a spectacular return.
Vegans and vegetarians often have nutrient deficiencies and lower BMI, which can increase the risk of fractures.
- The study found that vegans were 43% more likely to suffer fractures than meat eaters.
- Similar results were observed for vegetarians and fish eaters, though to a lesser extent.
- It's possible to be healthy on a vegan diet, though it takes some strategic planning to compensate for the nutrients that a plant-based diet can't easily provide.
Comparison of fracture cases by diet group
Credit: Tong et al.<p>The results showed that vegans were especially vulnerable to hip fractures, suffering 2.3 times more cases than meat-eaters. Vegetarians and pescatarians were also more likely to suffer hip fractures, though to a lesser extent.</p><p>One explanation may be that non-meat eaters consume less calcium and protein. Calcium helps the body build strong bones, particularly before age 30, after which the body begins to lose bone mineral density (though consuming enough calcium through diet or supplement can <a href="https://ods.od.nih.gov/factsheets/Calcium-Consumer/" target="_blank">help offset losses</a>). Lower bone mineral density means higher risk of fracture.</p><p>Protein seems to help the body absorb calcium, <a href="https://www.bonejoint.net/blog/did-you-know-that-certain-foods-block-calcium-absorption/#:~:text=Historically%2C%20nutritionists%20have%20warned%20that,may%20increase%20intestinal%20calcium%20absorption." target="_blank" rel="noopener noreferrer">when consumed in normal levels</a>. The recent study, along with past research, shows that people who don't eat meat tend to have lower levels of both protein and calcium. When the researchers accounted for non-meat eaters who supplemented their diets with calcium and protein, fracture risk decreased, but still remained significant.</p>
Credit: Pixabay<p>Another explanation is body mass index (BMI). Non-meat eaters tend to have a lower BMI, which is associated with higher fracture risk, particularly hip fractures. In the new study, vegans with a low BMI were especially likely to suffer hip fractures. That might be because having more body mass provides a cushioning effect when people fall.</p><p>Still, the study has some limitations. For one, White European women were overrepresented in the sample. The researchers also didn't collect precise data on the type of calcium or protein supplementation, diet quality or causes of fractures.</p><p>Another complicating factor: Producers of vegan products, such as plant-based milk, are increasingly fortifying foods with nutrients like calcium and protein, so modern vegans are potentially at lower risk of deficiency.</p><p>The researchers wrote that their findings "suggest that bone health in vegans requires further research."</p>