Food insecurity and Cancer Care: Understanding the relationship and exploring solutions

by Janet Munu

Problem/Significance

The United States is deemed a wealthy country, but the problem of food insecurity is prevalent. Feeding America, a hunger-relief organization in the United States, reported that 34 million people in the US, including 9 million children, face food insecurity (Feeding America, 2023). The growing need for food insecurity needs attention.

The United States Department of Agriculture's (USDA) definition of food insecurity "is the limited or uncertain availability of nutritionally adequate and safe foods or limited or uncertain ability to acquire acceptable foods in socially acceptable ways." USDA categorizes food security and insecurity into the following categories (The United States Department of Agriculture, 2023).

• High food security: “no reported indications of food-access problems or limitations”.

• Marginal food security: “one or two reported indications—typically of anxiety over food sufficiency or shortage of food in the house. Little or no indication of changes in diets or food intake”.

• Low food security: “Reports of reduced quality, variety, or desirability of diet. Little or no indication of reduced food intake.”

• Very low food security: “Reports of multiple indications of disrupted eating patterns and reduced food intake.”

The image below shows the prevalence of food insecurity in the U.S. household Food Insecurity

Statistics.

Food Insecurity and Cancer Care

Food insecurity is a growing concern among cancer patients, impacting their nutritional status and overall health. A study by Ganey et al. (2021) referenced that medically underserved cancer patients are more likely to be food insecure than the general population. In addition, based on the study of a cohort of underserved cancer patients in New York City, 56% of patients were food insecure; 38% had very low food security.

Cancer patients experience physical and emotional turmoil during their treatment and care. According to Gany et al. (2014), they represent a vulnerable population because of the disease process and the intensity of treatment protocols. During this phase, cancer patients require access to healthy food and adequate nutrition to maintain their energy levels, optimize immunity, and respond to treatment. Food insecurity is also associated with non-adherence to treatment protocols.

Several studies on food insecurity's impact on cancer care show evidence that it can contribute to adverse health consequences among cancer patients. They are prone to poor functional, social, and emotional well-being. Limited access to nutritious foods can lead to malnutrition, weight loss, and fatigue and impact their quality of life. These can undermine cancer treatment and increase the risk of complications. Individuals experiencing food insecurity tend not to seek medical care, and noncompliant with the treatment regimen, and miss appointments (Simmons, 2006). Furthermore, Mendoza (2022), speculates that the severity of food insecurity may lead to depression, and anxiety, impairing the ability to access preventive healthcare services such as screening for cancer.

Cause of Food Insecurity

Factors contributing to food insecurity among cancer patients include the high cost of cancer treatment, reduced income due to work disruption, and transportation barriers to healthy food. Food insecurity is also associated with non-adherence to treatment protocols Bengle (2010). Furthermore, cancer patients experience psychological stress, anxiety, or depression, which may exacerbate food insecurity by reducing their motivation to eat.

Addressing Food Insecurity

Addressing food insecurity among cancer patients is critical for improving their treatment outcomes and overall well-being. Below are suggested measures to address food insecurity for cancer patients.

• Enable patients with transportation to the local grocery stores and access to health care.

• Provide direct food assistance such as Meals on Wheels.

• Healthcare organizations are encouraged to screen patients for food insecurity (Feeding America, Simmons (2006). Screening cancer patients for food insecurity takes limited time but has the potential to have significant improvement in patient outcomes ASCO (2022)

• Refer patients to food assistance programs, connect patients to Supplemental Nutrition Assistance Program (SNAP), community food banks, senior meal programs, and up food set distribution to address the immediate need.
  

  
   Healthcare Addressing Food Insecurity

Considerations for Future Work:

• Raise awareness and advocate for policy changes.

• To positively impact patients' health and improve clinical outcomes, it is essential to extend care beyond the walls of the healthcare system and provide longitudinal care for patients with food insecurity.

• Gany (2021) suggests that cancer clinics set up a system with patient navigators, nutritionists, education and outreach coordinators, and social workers, case managers to provide comprehensive and timely assistance.

• Further research is needed to develop or use an existing framework to address food security based on the theories of Poverty.

Conclusion

In addition to providing cancer treatment, addressing food insecurity is crucial in cancer care. It is imperative to incorporate policy changes, collaborative research, implementing processes, and monitoring patients to ensure that cancer patients receive proper nutrition during and after treatment. Addressing the issue is essential for improving patient outcomes, overall health, and quality of life.

References

1. Bengle R, Sinnett S, Johnson T, Johnson MA, Brown A, Lee JS. Food insecurity is associated with cost-related medication non-adherence in community-dwelling, low- income older adults in Georgia. J Nutr Elder. 2010 Apr;29(2):170-91. doi: 10.1080/01639361003772400. PMID: 20473811.

2. Feeding America. (2023). What is Food Insecurity. Retrieved 2023 March 15 from https:// www.feedingamerica.org/hunger-in-america/food-insecurity

3. Gany F, Lee T, Ramirez J, Massie D, Moran A, Crist M, McNish T, Winkel G, Leng JC. Do our patients have enough to eat?: Examining the Association of Food Insecurity. J Health Care Poor Underserved. 2014 Aug;25(3):1153-68. doi: 10.1353/hpu.2014.0145. PMID: 25130231; PMCID: PMC4849892.

4. Gany F, Melnic I, Ramirez J, Wu M, Li Y, Paolantonio L, Roberts-Eversley N, Blinder V, Leng J. The association between housing and food insecurity among medically underserved cancer patients. Support Care Cancer. 2021 Dec;29(12):7765-7774. doi: 10.1007/s00520-021-06254-1. Epub 2021 Jun 24. PMID: 34169329; PMCID: PMC8225310.

5. Mendoza JA, Miller CA, Martin KJ, Resnicow K, Iachan R, Faseru B, McDaniels- Davidson C, Deng Y, Martinez ME, Demark-Wahnefried W, Leader AE, Lazovich D, Jensen JD, Briant KJ, Fuemmeler BF. Examining the Association of Food Insecurity and Being Up-to-Date for Breast and Colorectal Cancer Screenings. Cancer Epidemiol Biomarkers Prev. 2022 May 4;31(5):1017-1025. doi: 10.1158/1055-9965.EPI-21-1116. PMID: 35247884; PMCID: PMC9135358.

6. Simmons LA, Modesitt SC, Brody AC, Leggin AB. Food insecurity among cancer patients in kentucky: a pilot study. J Oncol Pract. 2006 Nov;2(6):274-9. doi: 10.1200/JOP.2006.2.6.274. PMID: 20859354; PMCID: PMC2793655.

7. U.S. Department of Agriculture, Economic Research Service. (n.d.). Key statistics & graphics. Retrieved April 29, 2023 from https://www.ers.usda.gov/topics/food-nutrition- assistance/food-security-in-the-us/key-statistics-graphics.aspx

8. https://hungerandhealth.feedingamerica.org/explore-our-work/community-health-care- partnerships/addressing-food-insecurity-in-health-care-settings/

Which Side Are You On? Policing, Prisons, & Abolitionist Nursing

 

Which Side Are You On?

Policing, Prisons, & Abolitionist Nursing      

The COVID-19 pandemic has fundamentally shifted public discourse around race, violence, and health. The converging crises of income inequality, police violence, and systemic racism collided with the SARS-CoV-2 virus and have created novel paradigm shifts in public health. The pandemic widened cracks in our societal structures and magnified existing divisions and inequality. Violent crimes and deaths are rising nationally, and stay-at-home orders and lockdowns resulted in increased rates of interpersonal violence and homicide ¹. COVID-19 has also caused an increase in secondary risk factors associated with interpersonal violence, namely substance use, mental health issues, unemployment and economic stress, and social isolation ². Against the backdrop of increased violent crime, the murder of George Floyd in 2020 by Minneapolis Police Officer Derek Chauvin sparked a national and global reckoning with racism, policing, and community safety. These dual trends have laid bare an inherent contradiction in approaches to violence: increased policing and mass incarceration do not lead to public safety.

 

The 3 P’s: Public Health, Police, and Prisons

The paradigm of social determinants of health (SDOH) has become the dominant theoretical and practical framework for public health nursing. The origins of SDOH lie in the roots of epidemiology and the sanitary campaigns of the early nineteenth century, which highlighted the interconnectedness of health, social position, and living conditions. Provision 8 of the American Nurses Association’s Code of Ethics highlights the importance of SDOH: “Nurses understand that the lived experiences of inequality, poverty, and social marginalization contribute to the deterioration of health.” Today, the SDOH paradigm is a central framework for health policy in the United States.

"The evidence is clear: social determinants of health, such as access to stable housing or gainful employment, may not be strictly medical, but they nevertheless have a profound impact on people’s wellbeing.” -Seema Verma, CMS Director

Discussing the social determinants of health without acknowledging the role of state-sanctioned violence is impossible. Policing and incarceration disproportionately impact poor and low-income communities, disabled people, immigrants, and communities of color ³. Incarceration shortens life expectancy by five years and has disastrous health effects, including high rates of chronic and infectious diseases, substance use, and mental health issues ⁴. Like SARS-CoV-2, structural institutions like healthcare and law enforcement don’t overtly discriminate against groups of people, but as Steven Trasher eloquently shares in his book The Viral Underclass, “their effects do discriminate against the bodies of the underclass, because those bodies have been placed in proximity to danger by the structural design of powerful humans.”

The American Public Health Association, the American Nurses Association, and the American Medical Association have all issued statements condemning the epidemic of racist police violence in the United States ^{5, 6, 7, 8}. While these statements represent an essential step in acknowledging the structural inequities in policing and prisons, they fail to identify how the carceral state maintains and upholds the structural determinants that cause health disparities in the first place. Ruth Wilson Gilmore’s concept of organized abandonment serves as a further call to action for healthcare workers to interrogate the entanglement of healthcare with prisons and policing. Gilmore argues that public health agencies, particularly education and healthcare systems, have absorbed policing and surveillance functions. At the same time, jails, prisons, and the police absorb social work and mental health care functions they are neither equipped nor want to perform. Organized abandonment has resulted in massive state and municipal budgets devoted to policing and jails, with commensurate disinvestment in the institutions that keep people out of the carceral system: schools, housing, and healthcare.

Nursing and public health values fundamentally contradict the practices of surveillance, policing, and incarceration. While the SDOH framework offers a paradigm for understanding the linkages between health, violence, and policing, it falls short of offering solutions. To address the upstream drivers of health inequities, nurses must move beyond understanding to action.

Abolitionist Nursing Praxis

 

Abolitionism is a critical framework that interrogates how healthcare is intertwined with police and prisons and offers a vision for health-based solutions to violence outside of the carceral state. Abolitionist theory is a political and social philosophy that aims to abolish or dismantle oppressive systems, such as slavery, racism, sexism, and other forms of social inequality. Abolitionist theory also argues that the prison system, rooted in punishment and retribution, perpetuates cycles of violence and fails to address the root causes of violence or crime. It questions our assumptions that violence is an inevitable feature of human society and that the existing systems of policing and incarceration are a necessary response to violence. These systems are neither inevitable nor permanent but instead emerged from specific political and economic contexts and are actively buttressed by influential people and institutions.

So, why is abolitionism relevant to nursing? Alternatives to policing and the criminal justice approach to violence are needed, and health-based interventions could fill this gap. Abolitionist nursing offers a theoretical framework that advocates separating healthcare from policing and incarceration and addresses the upstream drivers of violence and health outcomes ^{9, 10}. The healthcare system, however complex, is still a space that can offer refuge from harm and healing from violence. Abolitionist nursing redirects resources away from prisons and police and towards violence prevention, intervention, and healing. By expanding our SDOH framework to include an abolitionist lens, nurses can play a crucial role in understanding health inequities and preventing the state-sanctioned violence that creates and exacerbates those health inequities.

The COVID-19 pandemic has upended the healthcare system and generated high levels of mental exhaustion, trauma, and burnout among nurses and other healthcare staff. Nurses trained in an SDOH framework often struggle with a sense of futility and overwhelm: the upstream drivers of health inequities can seem impossible to tackle, and the patients and harm are endless. Abolitionist nursing offers an alternative framework that seeks not gradual reform of the structural institutions that drive violence and illness but moves nurses towards an ethic of mutual aid. In the words of Ruth Gilmore, “Abolition is not absence; it is presence…. So those who feel in their gut deep anxiety that abolition means knock it all down, scorch the earth and start something new, let that go. Abolition is building the future from the present in all ways we can.”

References:

1. Kourti, A., Stavridou, A., Panagouli, E., Psaltopoulou, T., Spiliopoulou, C., Tsolia, M., Sergentanis, T. N., & Tsitsika, A. (2023). Domestic Violence During the COVID-19 Pandemic: A Systematic Review. Trauma, violence & abuse, 24(2), 719–745. https://doi.org/10.1177/15248380211038690
2. Robinson, E., Sutin, A. R., Daly, M., & Jones, A. (2022). A systematic review and meta-analysis of longitudinal cohort studies comparing mental health before versus during the COVID-19 pandemic in 2020. Journal of affective disorders, 296, 567–576. https://doi.org/10.1016/j.jad.2021.09.098
3. Sawyer, W. (2020). Visualizing the racial disparities in mass incarceration. Prison Policy Initiative. https://www.prisonpolicy.org/blog/2020/07/27/disparities/?gclid=Cj0KCQjwr82iBhCuARIsAO0EAZxXUPO4GZT9o44RSTdX2MhnFsx_exdgAa4Sy_BVY71zCCj9aKSRuWYaAihJEALw_wcB
4. Healthy People 2030. Incarceration. https://health.gov/healthypeople/priority-areas/social-determinants-health/literature-summaries/incarceration#:~:text=Studies%20have%20shown%20that%20when,%2C%20hepatitis%20C%2C%20and%20HIV.
5. American Public Health Association. (2018, Nov 18). Addressing law enforcement violence as a public health issue. https://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2019/01/29/law-enforcement-violence
6. American Public Health Association. (2021, Oct 26). Advancing public health interventions to address the harms of the carceral system. https://www.apha.org/Policies-and-Advocacy/Public-Health-Policy-Statements/Policy-Database/2022/01/07/Advancing-Public-Health-Interventions-to-Address-the-Harms-of-the-Carceral-System
7. American Nurses Association. (2020, Jun 20). Resolution on racial justice for communities of color. https://www.nursingworld.org/news/news-releases/2020/ana-calls-for-racial-justice-for-communities-of-color/
8. American Medical Association. (2020, Nov 17). AMA policy recognizes police brutality as a product of structural racism. https://www.ama-assn.org/press-center/press-releases/ama-policy-recognizes-police-brutality-product-structural-racism
9. Khan, Z., Iwai, Y., & DasGupta, S. (2022). Abolitionist reimaginings of health. AMA Journal of Ethics. https://journalofethics.ama-assn.org/article/abolitionist-reimaginings-health/2022-03
10.  Paynter, M., Jefferies, K., Carrier, L., & Goshin, L. (2022). Feminist Abolitionist Nursing. ANS. Advances in nursing science, 45(1), 53–68. https://doi.org/10.1097/ANS.0000000000000385

 

 

 

 

Planetary Health: A Paradigm Shift into Interdependence

 by Elisabeth Osgood-Campbell 

Introduction

When Copernicus radically proposed that the Earth was not the center of the universe, he challenged the geocentric view of the planets with a heliocentric view in which the Earth and other celestial bodies are understood to revolve around the sun (Crotty, 1998). On a smaller scale, within the scope of life on our beautiful, blue planet, an emerging paradigm shift to planetary health asserts that humans are not isolated at the top of an evolutionary pyramid, in control of all life forms “beneath” them. Instead, the framework of planetary health views humans, and their health, as embedded in interdependent relationships with animals and other elements in our ecosystems. Some schools of nursing like the University of Minnesota, Massachusetts General Hospital Institute of Health Professions, and Yale University, have created planetary health initiatives to advocate for ‘better health for all people…and the planet.’

Figure 1

 

Health Paradigms

A paradigm is comprised of a set of beliefs and ideas, or a model, for understanding a topic (Crotty, 1998). For centuries in Western cultures, the dominant health paradigm has viewed wellness as an individual phenomenon, defined by the proper functioning of physiological systems (Arah, 2009). If the various processes such as breathing, circulation, digestion, and immunity proceed as usual, a person has generally been deemed to be healthy. Clinical medicine has focused on diagnosing and treating dysfunctions of particular systems like lung disease, heart disease, and irritable bowel syndrome, to name a few. However, at various points in history, many cultures have also incorporated an understanding of public or population health by acknowledging external influences on the well-being of communities of people including lifestyle (e.g., nutrition) and immediate environment (e.g., sanitation). (Tulchinsky & Varavikova, 2014). In fact, in 1859, Florence Nightingale’s Environmental Theory defined nursing as “the act of utilizing the patient’s environment to assist him in his recovery” (Lilienfeld et al., 2018, p.487). Key elements to support patient health in her theory included fresh air, pure water, efficient drainage, cleanliness, and sunlight.

While population health has historically focused on community health within a particular region or country, the concept of international health that emerged in the late 19th century addressed medical issues that spanned national borders, i.e., epidemics like the Spanish flu. Next, with the creation of the World Health Organization in 1948, the paradigm of global health emerged (Brown et al., 2006). This framework similarly considers the health needs of people in a very large geographic area rather than specific nations, but it also focuses on medical issues that have global impact or need to be addressed through global solutions (Chen et al., 2020).

 

Crises Spur Paradigm Shifts

According to philosopher Thomas Kuhn, a paradigm shift occurs when current findings are not adequately explained by the dominant paradigm (Crotty, 1998). In the past two decades, environmental crises have forced a revision of conventional approaches to individual, population, and global health. The detrimental effects of toxins in our water, soil, and air, from the contamination of the public water supply in Flint, Michigan, to the derailment of a train carrying toxic chemicals in Ohio this past February, are becoming increasingly clear to both the general public and medical professionals. In fact, in the emerging field of geomedicine, geographic information systems (GIS) can inform healthcare workers about environmental hazards such as asbestos or contaminated water in the region of a person’s home or school (Setia et al., 2017). Medical issues associated with climate change events such as more frequent wildfires, floods, and hurricanes have also become more obvious in recent years. Increasingly, human health is viewed in the context of ecological phenomena that are associated with global warming (Figure 2). Some nursing programs have noticed this trend and have spearheaded a new paradigm in Western medicine that reframes human health as interdependent on the health of the planet (Rosa & Upvall, 2018).

 

Figure 2

 

The Planetary Health Paradigm

The planetary health paradigm approaches health not as a solely human-based phenomenon, but rather as an interconnected web of relationships among animal, human, and ecosystem well-being (Rosa & Upvall, 2018). It also asserts that climate crises are the greatest threat to human health worldwide (Lilienfeld et al., 2018). Additionally, the framework of planetary health comprises more than an awareness of the humanitarian crisis that our changing climate presents. Sadly, but not surprisingly, resource-rich countries (e.g., the U.S.)  contribute most to climate change, but those living in resource-poor countries are often the most vulnerable, suffering more direct adverse effects (ibid). Thus, climate change also presents an urgent social justice challenge. Accordingly, the paradigm of planetary health calls for massive collaboration across disciplinary and national boundaries to address health inequities that will be further exacerbated by global warming.

The paradigm shift to planetary health may be “new” in the context of contemporary Western medicine, but the idea that humans are embedded in the web of life and that the health of individuals depends on the health of communities and ecosystems has existed in indigenous cultures across the globe for millennia.  Below, Figure 3 depicts an indigenous perspective on health that emphasizes interdependence between multiple aspects of individual and community wellness, including the natural environment (Gallagher, 2019).

 

Figure 3

 

The Role of Nursing in this Paradigm Shift

As nurses care for people individually and in communities, they are in a unique position to advocate for planetary health and mitigate the negative effects of climate crises in multiple ways (Kurth, 2017). For example, nurses can educate patients about the personal and collective benefits of decreasing greenhouse gasses by eating more plant-based foods and walking rather than driving. Nurses can also encourage a reduction of their workplace carbon footprints through more economical use of resources such as electricity and water as well as paper and plastic products. In addition, nursing schools can integrate planetary health curricula into their programs. Furthermore, nurses can broaden their traditional roles beyond providing healthcare services and advocate for policy changes on local, state and federal levels to minimize the impact of climate crises on the immediate and more distant future. This paradigm shift will also shape nursing research science in the years to come. Here are a few of the countless questions that could be investigated through a planetary health lens:

• What effect does climate change anxiety have on stress levels and immune function?
• What impact does climate change activism have on stress levels and immune function?
• What effect does time spent outdoors in the natural environment have on stress levels and immune function?

 

Conclusion

              Driven by an increasing awareness of the impact of climate crises on human well-being, the paradigm shift from individual, public, and global health to planetary health seems inevitable. Reflecting ancient indigenous views of the interrelatedness of human and ecological health, this framework has the potential to alter current nursing practices, roles, and research. However, widespread adoption of this perspective will require extensive education, collaboration, and financial resources. Hopefully, healthcare professions will be able to respond effectively to the complex challenges and opportunities that this new paradigm presents. The health of the planet depends on it.

 

 

Resources 

https://nursing.umn.edu/about/planetary-health

https://www.mghihp.edu/nursing/centers-initiatives/center-climate-change-climate-justice-and-health

https://nursing.yale.edu/global-affairs-planetary-health/planetary-health-initiatives

https://www.britannica.com/event/Flint-water-crisis

https://www.nytimes.com/article/ohio-train-derailment-timeline.html

https://www.planetaryhealthalliance.org/planetary-health

 

 

References

Arah O. A. (2009). On the relationship between individual and population health. Medicine, health care, and philosophy, 12(3), 235–244. https://doi.org/10.1007/s11019-008-9173-8

Brown, T. M., Cueto, M., & Fee, E. (2006). The World Health Organization and the transition from "international" to "global" public health. American Journal of Public Health, 96(1), 62–72. https://doi.org/10.2105/AJPH.2004.050831

Chen, X., Li, H., Lucero-Prisno, D. E., 3rd, Abdullah, A. S., Huang, J., Laurence, C., Liang, X., Ma, Z., Mao, Z., Ren, R., Wu, S., Wang, N., Wang, P., Wang, T., Yan, H., & Zou, Y. (2020). What is global health? Key concepts and clarification of misperceptions: Report of the 2019 GHRP editorial meeting. Global health research and policy, 5, 14. https://doi.org/10.1186/s41256-020-00142-7

Crotty, M. J. (1998). The foundations of social research: Meaning and perspective in the research process. The foundations of social research, 1-256.

Gallagher J. (2019). Indigenous approaches to health and wellness leadership: A BC First Nations perspective. Healthcare management forum, 32(1), 5–10. https://doi.org/10.1177/0840470418788090

Kurth, A. E. (2017). Planetary health and the role of nursing: A call to action. Journal of Nursing Scholarship, 49(6), 598-605.

Lilienfeld, E., Nicholas, P. K., Breakey, S., & Corless, I. B. (2018). Addressing climate change through a nursing lens within the framework of the United Nations Sustainable Development Goals. Nursing Outlook, 66(5), 482-494.

Rosa, & Upvall, M. J. (2019). The case for a paradigm shift: from global to planetary nursing. Nursing Forum (Hillsdale), 54(2), 165–170. https://doi.org/10.1111/nuf.12310

Setia, S., Singh, S., Mathur, A., Makkar, D. K., & Pal, V. (2017). Health care and geomedicine: a review. World Journal of Environmental Biosciences, 6(1), 1-3.

Tulchinsky, T. H., & Varavikova, E. A. (2014). A History of Public Health. The New Public Health, 1–42. https://doi.org/10.1016/B978-0-12-415766-8.00001-X

"The Doctor will see you now" - From Emergency Medical Hologram to Algorithmovigilience

by Rachel Buchleiter, PhD student

Fair use, https://en.wikipedia.org/w/index.php?curid=4957180

The future is now?

It is easy to think that because a computer is not a human, it is exempt from the limitations and constructs of humans in society. It should be impartial, “color-blind”, unbiased and fair in all computations. The reality is, computers were designed by humans and therefore these machines inherit some of the same flaws. One example of this is the phenomena of bias in computer generated algorithms, known as artificial intelligence (AI) or machine learning (ML). For more information how ML fits into AI (and other buzz words) check out this explanation. When the term "Artificial Intelligence" was first coined in 1957 some speculated that it would become some autonomous robot, capable of all sorts of things, including replacing humans in some capacity. In reality, at least for now, the technology is nowhere near that. Instead, AI is far more useful at automating many routine tasks and decisions, reducing human workload, but not with the depth or range previously showcased in science fiction. Along with this realistic application of AI comes some serious ethical dilemmas to confront. This includes bias inherent in the algorithms generated by ML. (Broussard, 2023; Igoe, 2021)

 

Some of the places where this bias has become apparent:  

• Facial recognition software - a black student had to use a white mask in order to program her Mirror product, based on facial recognition (Broussard, 2023)
• Amazon hiring algorithm (Dastin, 2018)
• Cardiovascular risk prediction models (Igoe, 2021)

Why is this?

As a general rule of thumb, algorithms are only as good as the datasets they are built upon. This is often referred to as "garbage in, garbage out." The main sources for healthcare related data include electronic health records (EHR), and insurance claims. Often, the lack of interoperability and information exchange, or inconsistent care, results in incomplete health records. When a patient receives care from different locations, using different EHRs, the patient's complete record cannot always be analyzed for a wholistic view of treatment. Due to systemic inequities, these data sets typically contain more Caucasian patients who are consumers of the healthcare system. This results in an underrepresentation of minority patients and uninsured patients, perpetuating the marginalization of these populations (Gervasi & Chen, et al., 2022; Igoe, 2021).

 

Healthcare specific implications

Major tech giants, not always traditionally thought of as healthcare companies, are popping up in healthcare discussions. These include Google, Microsoft, IBM and Apple (Powles & Hodson, 2017). This influx of resources to the marathon of equity in healthcare is much needed, but should proceed with caution. The main aims of the movement are to improve the accuracy of medical diagnoses, predict diseases and assist healthcare professionals in reaching the quadruple aim (improve quality, efficiency, reduce costs and improve clinician and patient experience). (Parashar, Chaudhary & Rana, 2021) With demonstrated examples of bias within these diagnosis and treatment algorithms it is imperative to design unbiased systems and promote equity in all phases of healthcare.

 

Steps to mitigate bias

The concept of algorithmovigilience, "refers to scientific methods and activities relating to the evaluation, monitoring, understanding and prevention of adverse effects of algorithms" (Gervasi & Chen, et al., 2022). These principles must be driven by the industry and government agencies. Both the United States and the European Union have proposed guidelines for diversity, nondiscrimination, fairness and equity in ML. In response to the recent wildfire like spread of AI, the White House has published the AI Bill of Rights. Numerous other agencies provide guidance to improve the accuracy and fairness of algorithms, although this is highly dependent on data quality. In any AI development, especially healthcare, steps to eliminate bias should be taken at every step of the process. This starts with the population identified for data collection, gathering a diverse sample data set, the format in which data is stored, all the way to the output and analysis of data (Gervasi et al., 2022). It also includes a diverse representation on the development team to provide input along the way (Igoe, 2021) While it is not a silver bullet, using an appropriately diverse data set for algorithm training is foundational.

The path toward equity does not end with just the data however, it is imperative to be judicious in selecting applications for AI. In her book, More than a Glitch, Meredith Broussard argues against the use of AI in policing for example. The use of predictive analytics in crime prevention has unintended consequences. The same exercise should apply to development of ML algorithms in healthcare. What are the potential benefits to use ML for a certain diagnosis? Who or what might be overlooked in this algorithm? Is this treatment plan equitable for all patients? Is this an ethical application of AI

The humans who designed AI in the first place must strive to end the cycle of bias and inequity in healthcare which each technological advancement. This shift in thinking about the objectivity of computers to algorithmovigilience is critical to reach the goal of equitable healthcare for all.

 

References:

Broussard, M. (2023). More than a glitch: confronting race, gender and ability bias in tech. MIT Press.

Brown, S. (2021, April 21). Machine learning, explained. MIT Management, Ideas made to matter| Artificial Intelligence. https://mitsloan.mit.edu/ideas-made-to-matter/machine-learning-explained

Dastin, J. (2018, October 10). Amazon scraps secret AI recruiting tool that showed bias against women. Reuters: Retail. https://www.reuters.com/article/us-amazon-com-jobs-automation-insight/amazon-scraps-secret-ai-recruiting-tool-that-showed-bias-against-women-idUSKCN1MK08G

Igoe, K. J. (2021, March 12). Algorithmic bias in health care exacerbates social inequities – how to prevent it. Harvard T.H. Chan School of Public Health. https://www.hsph.harvard.edu/ecpe/how-to-prevent-algorithmic-bias-in-health-care/

Gervasi, S. S., Chen, I. Y., Smith-McLallen, A., Obermeyer, Z., Vennera, M. & Chawla, R. (2022). The potential for bias in machine learning and opportunities for health insurers to address it. Health Affairs 41(2)https://doi.org/10.1377/hlthaff.2021.01287

Parashar, G., Chaudhary, A. & Rana, A. (2021). Systematic Mapping Study of AI/Machine Learning in Healthcare and Future Directions. SN COMPUT. SCI. 2, 461. https://doi.org/10.1007/s42979-021-00848-6

Powles, J., Hodson, H. (2017). Google DeepMind and healthcare in an age of algorithms. Health Technol. 7, 351–367. https://doi.org/10.1007/s12553-017-0179-1

 

 

Finding a purpose to combat eco-anxiety

by Kate Flynn

“We cannot be studied or cured apart from the planet” – James Hillman

 

Eco-anxiety

In 2019 climate anxiety was the “biggest pop-culture trend,” “climate emergency” was the word of the year by Oxford, and 71% of millennials expressed that climate change had a detrimental impact on their mental well-being (McGinn, 2019; Oxford, 2023; Hickman, 2021). Many feel helpless and guilty for living in an industrialized nation, thinking they are making the problem worse and not knowing how to contribute positively (Wray, 2022). In 2017 the American Psychological Association defined eco-anxiety as the “chronic fear of environmental doom” (Clayton, 2017). In this blog post, I hope to validate your eco-anxiety and motivate you to participate in change; for yourself, your family, your community, your patients, your future, and the world.

 

Silos to policy

Nursing is dramatically shifting from practicing in silos to tackling the root cause of those adverse events at the policy level. This paradigm shift is referred to as global to planetary health. What do I mean by this?

In the past, as healthcare providers, we have stayed in our lanes so to speak. As an operating room (OR) nurse, I worked on issues specifically related to the OR and was seen as an overstep to ask about issues related to state or federal politics or issues seen to be outside of the hospital. Now, we are starting to understand our responsibility to our patients outside of the hospital and prevent the causes of their disease states in the first place.

 

 

 

 

 

 

 

The connection

Eco-anxiety

Take comfort

“Eco-distress is a sign of connection to the world; it is a normal reaction to the injustices being inflicted upon the planet and its living creatures” (Wray, 2022, p 35)

 

Purpose

“anxiety about the climate… must be harnessed and purposefully directed outward for justice-oriented results” (Wray, 2022, p 29)

 

 

 

 

 

 

 

As the effects of climate change become increasingly evident, many people worldwide are experiencing eco-anxiety, a term used to describe the anxiety and stress related to environmental issues. This includes concerns about the impact of climate change on the planet, its ecosystems, and its inhabitants. A 2021 survey showed that 71% of millennials feel climate change negatively impacts their mental health. This phenomenon has given rise to a new paradigm in nursing called "planetary nursing."

Planetary nursing is a concept that is gaining popularity in the healthcare sector as nurses and healthcare providers become more aware of the impact of environmental issues on human health. It promotes health and well-being by addressing the root causes of environmental problems, such as pollution, climate change, and unsustainable lifestyles.

The concept of planetary nursing involves a shift in thinking from a traditional focus on individual patient care to a more holistic approach that considers the broader environmental context. It acknowledges that health is not just about treating illness but also promoting a healthy environment and preventing disease. By addressing the root causes of environmental problems, planetary nursing can help to reduce the incidence of health problems caused by environmental factors.

In addition to promoting health and well-being, planetary nursing offers nurses and healthcare providers a sense of purpose and meaning in their work. By working towards a healthier planet, nurses can feel they are making a meaningful contribution to society and the world.

There are many ways that nurses and healthcare providers can contribute to planetary nursing. For example, they can advocate for policies that promote environmental sustainability, incorporate environmental education into patient care, and promote sustainable practices in healthcare facilities.

In conclusion, eco-anxiety is a growing concern for many people, and planetary nursing offers a promising new approach to addressing the environmental issues that underlie it. By promoting health and well-being through sustainable practices and policies, nurses and healthcare providers can make a meaningful contribution to the planet's health and its inhabitants while finding purpose and meaning in their work.

 

 

References

Gist

2019’s biggest pop-culture trend was climate anxiety: Billie Eilish, “Big Little Lies,” Megan Thee Stallion’s Instagram Live: The climate crisis kept popping up in unexpected places.

Dec 27, 2019

Miyo McGinn

https://grist.org/politics/2019s-biggest-pop-culture-trend-was-climate-anxiety/

Oxford Languages

Oxford University Press

2023

Word of the Year 2019

https://languages.oup.com/word-of-the-year/2019/

 

https://seechangeinstitute.com/wp-content/uploads/2022/03/Climate-Change-and-Youth-Mental-Health-Report.pdf

 

https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(21)00278-3/fulltext

 

 

Hickman, Marks, E., Pihkala, P., Clayton, S., Lewandowski, R. E., Mayall, E. E., Wray, B., Mellor, C., & van Susteren, L. (2021). Climate anxiety in children and young people and their beliefs about government responses to climate change: a global survey. The Lancet. Planetary Health, 5(12), e863–e873. https://doi.org/10.1016/S2542-5196(21)00278-3

 

156 Haaland, M. (2021, September 6). Majority of young American adults say climate change influences their decision to have children. SWNS Digital. NOTE: The methods of this survey were not made available, so we cannot determine the quality of this survey data. The percentages cited could be artificially high due to selection bias or other issues. While the percentages may not be accurate, the general findings that the reality of climate change impacts important life decisions among youth is supported by other research.

 

Marks, E., et al. (2021). Young people’s voices on climate anxiety, government betrayal and moral injury: A global phenomenon.

 

 

Kurth, & Pihkala, P. (2022). Eco-anxiety: What it is and why it matters. Frontiers in Psychology, 13, 981814–981814. https://doi.org/10.3389/fpsyg.2022.981814

 

https://www.frontiersin.org/articles/10.3389/fpsyg.2022.981814/full

 

 

Dockett. (2019). The Rise of Eco-Anxiety. Psychotherapy Networker, 43(1), 11–14.

 

Bilski, J. (2022, June 5). Volume 9: Back to basics. River People Rebuild. https://riverpeoplerebuild.substack.com/p/volume-9-back-to-basics

 

Wray, B., & Bilski, J. (2023, April 27). “Why I’m so happy about eco-anxiety:” Writer Jared Bilski talks about living through a natural disaster. Gen Dread. https://gendread.substack.com/p/why-im-so-happy-about-eco-anxiety

 

 

 

Clayton, S., Manning, C., Krygsman, K., & Speiser, M. (2017). Mental health and our changing climate: Impacts, implications, and guidance. Washington, DC: American Psychological Association and ecoAmerica.

https://www.apa.org/news/press/releases/2017/03/mental-health-climate.pdf

 

Kurth, & Pihkala, P. (2022). Eco-anxiety: What it is and why it matters. Frontiers in Psychology, 13, 981814–981814. https://doi.org/10.3389/fpsyg.2022.981814

 

https://www.apa.org/monitor/2021/03/ce-climate-change

 

My life would have followed a very different trajectory if the climate crisis had been tackled when Dr James Hansen first warned the world in 1988 – a few years before I was born.”

https://gendread.substack.com/p/heres-what-you-shared-about-your

 

https://openclipart.org/detail/305988/flag-map-of-the-world

 

https://openclipart.org/detail/269592/embrace-the-world

 

https://openclipart.org/detail/323610/brain-plab

 

https://openclipart.org/detail/281124/medical-icons-medicine-typography

 

https://openclipart.org/detail/281072/medical-icons-caduceus

 

https://openclipart.org/detail/326505/medical-icons-frame-earth

 

https://openclipart.org/detail/320060/doctor-in-mask

 

https://openclipart.org/detail/281542/man-in-hospital

 

https://openclipart.org/detail/327276/people-speaking-up

 

https://openclipart.org/detail/279757/heart-stethoscope-2

 

https://openclipart.org/detail/281063/medical-icons-tree

 

https://openclipart.org/detail/293474/outubro-rosa-pink-october-svg

 

https://openclipart.org/detail/175882/the-capital

 

https://openclipart.org/detail/315295/english-teacher

 

https://openclipart.org/detail/314157/young-protesters

 

https://openclipart.org/detail/196219/la-unidad

 

La Unidad = unity, undivided, oneness

 

https://nappy.co/photo/1858

Girl smelling sunflower

 

 

https://openclipart.org/detail/279572/silo

 

https://openclipart.org/detail/12603/arrow-next

 

https://medium.com/unpsychologymag/the-destruction-of-experience-how-ecopsychology-has-failed-ccae9f36d7a4

 

https://www.caroline-hickman.com/climate-psychology

 

https://theconversation.com/im-up-late-at-night-worrying-about-global-warming-please-can-you-put-my-mind-at-rest-124940

 

 

Hoggett. (2019). Climate psychology : on indifference to disaster.