Choose your parents wisely! If not, choose your world wisely! Prognosing the lives of the yet unborn

Looking back at 2014, four events told the story of our world’s public health: 1) scientists blacklisted the phrase “Nature versus Nurture;” 2) release of the English version of Capital in the 21st century; 3) booming business of cord blood banks; and 4) Sustainable Development Goals (SDGs) of the United Nations. I wondered what the yet unborn children were contemplating about their world on January 1, 2015.

 

 

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We do not inherit the land from our ancestors; we borrow it from our children.

                                                                                                                                                                                                     African saying

 

I never met Reuel Stallones. An outstanding epidemiologist in the area of genetics and cardiovascular disease and founding dean of the University of Texas School of Public health (UTSPH) whose architectural design reflected the curricular structure, which was multidisciplinary and modular, and said to be built on the principles of learning put forth by renowned humanist psychologist, Carl Rogers.

 

I attended UTSPH more than a decade after Dr. Reuel Stallones (1923 – 1986) had passed away. I wish I had met him because the pithy aphorism: Choose your parents wisely is attributed to Stallones’ “Ten Rules of Perfect Health” lecture which included his precepts for a long, health and productive life (see Schull and Labarthe, 1986).

 

In fact I never heard Stallones talk about these rules because I never met him. However, I heard this story from a couple of professors at UTSPH who talked about how. Stallones (Stony) would advertise his lecture in the notice boards. The lecture hall would fill up with eager public health and medical students wanting to hear the guru of ischemic heart disease epidemiology expound on how to be healthy. Stallones would theatrically pick up a piece of chalk, and, with a flourish, write on the board: Rule Number 1: Choose your parents wisely.

 

Stony would then pause for that dramatic effect that every lecturer aspires to master.

 

I heard a story about a diligent student who was taking notes on how to be healthy. When Stony paused for drama, there was silence for a few seconds, and this student looked up and asked with a lot of enthusiasm and curiosity: What about Rule Number Two? They say Stallones’ calm, almost stoic, reply was: First go and fulfil Rule Number One and then ask me about the other nine rules.

 

What are those nine rules? Will we ever know?

 

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As I sit in Mumbai in 2015, looking back at 2014, far away from the university in Houston and the time when Stony’s lectures were abuzz with debates on health, I wondered what Stallones meant when he said: Choose your parents wisely.

 

I looked back at the events of 2014 from a public health or health policy perspective, and four separate occurrences stood out. One was the finding from a survey with a group of scientists at the start of the year which showed agreement in the scientific community that the phrase “Nature versus Nurture” and all that it represented should be permanently deleted from our intellectual hard drive. The second was the release in April 2014 of the English edition of Thomas Piketty’s book Capital in the 21st century. The third was the general rise in the business of umbilical cord blood. And the fourth was on 19 July 2014 when the United Nations (UN) General Assembly’s Open Working Group on Sustainable Development Goals (SDGs) forwarded to the Assembly its proposal for a set of SDGs for the world.

 

I looked at each of these four events to understand: Choose your parents wisely.

 

Stallones was a genetic epidemiologist and so he must have meant the effect of genes on health. As he used to say: One of the strongest predictors of health and longevity is a family history of long lived parents and grand-parents. However, Stallones was also a social epidemiologist and he knew the data on how poor families are likely to have disproportionate burden of disease and death as compared to their wealthy counterparts. Stallones believed that a child in Mississippi should have the equal opportunity for survival, health, and education as a child in Connecticut.

 

The public imagination, including popular culture films and books, has always been taken by the nature versus nurture debate: genes or the environment. Expressions such as – The apple does not fall far from the tree; Cut from the same cloth; A chip from the old block; Like father like son – are used very often in everyday conversation. Or as Sophocles said: From a bad crow, a bad egg. However, from a public-policy perspective, nature has always been taken as a given. Individuals can influence the genes their children inherit by choosing the right partner, but the state is concerned only with how children are nurtured.

 

From Nature versus Nurture to nature AND nurture

 

Choose your parents wisely. The use of this phrase invariably brings to mind the Nature versus Nurture dispute. One of the oldest arguments in psychology and popular debate about human actions; it tries to answer the question: What makes a person himself or herself? And what causes the differences in physical or behavioural features of individuals? Is the person’s development determined by her genes or is it determined by the environment in which she grew up, the upbringing and attendant life experiences.

 

Every year “www.edge.org” asks a group of scientists and thinkers to respond to a single question. In 2014, the question was: Which scientific ideas should be retired? Most scientists agreed that the familiar distinction between nature and nurture has outlived its usefulness, and should be retired.

 

Credit with coining of the phrase Nature and Nurture goes to Francis Galton (1822 – 1911), a distant cousin of naturalist Charles Darwin and independent scientist in his own right.

 Francis_Galton_1850s pic1

 

The phrase ‘nature and nurture’ is a convenient jingle of words, for it separates under two distinct heads the innumerable elements of which personality is composed. Nature is all that a man brings with himself into the world; nurture is every influence without that affects him after his birth.

— Sir Francis Galton

English Men of Science: Their Nature and Nurture (1874), 12.

 

It is said that Galton was one of the early scientists to try to examine and discuss the importance and causes of individual differences. Prior to Galton the phenomenon of individual differences had not been considered a subject for serious study in psychology.

 

I have no patience with the hypothesis occasionally expressed, and often implied, especially in tales written to teach children to be good, that babies are born pretty much alike, and that the sole agencies in creating differences between boy and boy, and man and man, are steady application and moral effort. It is in the most unqualified manner that I object to pretensions of natural equality. The experiences of the nursery, the school, the University, and of professional careers, are a chain of proofs to the contrary.

—  Francis Galton, Hereditary Genius

 

However, Galton was fighting against the ideas of a heavyweight in the field, who had already positioned “nurture” as the manner by which all humans acquired their behavioural traits. Regarded as one of the most influential of Enlightenment thinkers, English philosopher and physician John Locke (1632 -1704) predated Francis Galton (1832 – 1911). Locke had already proposed his theory of the tabula rasa (“blank slate”) that no child had any innate ideas at birth. Locke was also challenging the ideas of Rene Descartes before him. Locke argued that all knowledge was gained or acquired from experience and through the sense perceptions following his strong leaning towards empiricism, in the tradition of Sir Francis Bacon. Locke’s theory of mind, cited as the origin of modern conceptions of identity and the self, figured prominently in the work of later philosophers such as Hume, Rousseau, and Kant.

 

The publication of Darwin’s book The Origin of Species greatly influenced and galvanized Galton.

 Charles_Darwin pci1

 

The publication in 1859 of the Origin of Species by Charles Darwin made a marked epoch in my own mental development, as it did in that of human thought generally. Its effect was to demolish a multitude of dogmatic barriers by a single stroke, and to arouse a spirit of rebellion against all ancient authorities whose positive and unauthenticated statements were contradicted by modern science.

— Sir Francis Galton

Memories of My Life (1908), 287.

 

Galton became highly interested in the new theory and went about applying the evolution theories to his study of individual differences. It was not just the evolution of physical characteristics, but the evolution of mental characteristics that caught his attention. Galton developed his own theories on inherited traits. He studied identical twins, and worked on the first intelligence test in his exploration of the roles of “nature and nurture.” Galton devised some of the first tests of mental ability; it is said that he initiated the whole idea of mental tests. He used questionnaires to get a glimpse of people’s minds, devised the first tests to measure the association between ideas in a subject’s mind. Based on the assumption that intelligence could be measured in terms of one’s level of sensory capacity – the higher the intelligence, the higher the level of sensory discrimination. He devised a number of such instruments to measure the senses.

 

According to some sources, Galton also coined the term “eugenics,” a controversial field of study about selective breeding in humans to produce preferred traits. Galton’s ultimate interest was in encouraging the productivity of the more eminent or fit, and discouraging the birth rate of the unfit. By using the science of eugenics, the human strain, like livestock, could be improved by artificial selection. Galton believed that if men and women of considerable talents were selected and mated generation after generation, a highly gifted race of people would be the eventual result.

 

One of the effects of civilization is to diminish the rigour of the application of the law of natural selection. It preserves weakly lives that would have perished in barbarous lands.

“Hereditary Talent and Character” in MacMillan’s Magazine Vol. XII (May – October 1865), p. 326.

 

Nature and nurture seem to be two diametrically opposed realms and the use of oppositional ideas to advance debate and discussion has a long history in our way of thinking. In recent years, Ferdinand de Saussure (1966), argued that concepts have no meanings in themselves but derive their meanings from being in systems or networks of relationships. Their meanings are differential, and not defined by positive content but negatively, by their relationship with other concepts. Thus, one sees the same elements of oppositions being used in one of the foundational works in modern sociology The Elementary Forms of the Religious Life by one of the founding fathers Emile Durkheim (1967), a classic study of religious thought and its relation to the social order. Durkheim explains how religious thought divided the world into two distinct spheres – the sacred and the profane. Thus the sacred cannot exist without the profane, and vice versa (see Berger, 1995).

 

However, today Nature versus Nurture is reported as a meaningless debate. It is considered an obvious fact that both nature and nurture play important roles in human development as many of the scientists participating in the Edge survey pointed out. Recent scientific advances have made the very idea of these distinctions facile.

 

The growth of knowledge in the field of epigenetics tells us there is a long and circuitous route, with many feedback loops, from a particular set of genes to a feature of the adult organism. Epigenetics explores ways on which different environments shape this complex process of expression of a gene, including whether a gene is expressed at all. In their article titled: Beyond Nature vs. Nurture, Darlene Francis and Daniela Kaufer write that researchers studying differences in how individuals respond to stress are finding that genes are malleable and environments can be deterministic. “The “nature vs. nurture” conundrum was reinvigorated when genes were identified as the units of heredity, containing information that directs and influences development. When the human genome was sequenced in 2001, the hope was that all such questions would be answered. In the intervening decade, it has become apparent that there are many more questions than before.”

 

In a study conducted with pairs of identical and fraternal twins at Stanford University, a team of researchers led by Mark Davis, found that the environment may have played a larger role than genes in determining the response of the immune system. Examining blood samples, drawn from these twins at three different times, the researchers studied 200 distinct immune system components, and found that in almost 75% of these measurements, non-heritable influences such as exposure to toxic substances, vaccinations, diet, dental hygiene accounted for larger share of differences among twins as compared to heritable factors genes). Davis and his team concluded that: “While genomic variation clearly plays a role in some diseases, the immune system has to be adaptable to cope with infection and injury.” As Francis and Kaufer wrote in their article mentioned above: “We’ve reached a point where most people are savvy enough to know that the correct response isn’t “nature” or “nurture,” but some combination of the two.”

 

Frameworks to explain how the human mind develops have portrayed the process as some mix of genes and environment, innate structure and learning, evolution and culture. But the Nature versus nurture debate made it seem that we could actually study and assess the contribution of each of these causal factors independently.

 

In order to distinguish genetic and environmental contributions to the expression of adult behaviour in mice, Darlene Francis and her colleagues at Emory University investigated the effects of prenatal (embryo transfer) and postnatal (cross-fostering) environments in two strains of inbred mice with profound and reliable differences in behaviour. They published the results in an article in the journal Nature Neuroscience. Inbred mouse strains are normally used to search for genes associated with behavioural traits, including emotionality. One strain was “timid or anxious” in entering new environments or had difficulty learning during a stressful task compared to the other strain which could be called more “relaxed.” Evidence had shown that in the relaxed strain the mothers licked and groomed their babies more than in the anxious strain. This worried the people on the “Nature” side of the debate because it seemed that mothering style or nurture affected the behaviour. However, when relaxed strain mice pups were raised by the anxious strain mums, they grew up to be relaxed rather than timid. This finding, in turn, relaxed those arguing for genetics and “nature” to explain the differences between individuals.

 

Darlene Francis and her team then went further; using the techniques of in-vitro fertilization, they cross-fostered mice as embryos. Relaxed strain eggs that were fertilized were implanted into the anxious or timid strain females, who then carried this pregnancy to term. After birth some of these babies who were born out of the cross-fertilization were divided among mothers of both strains: some baby mice were raised by the “anxious” mothers and some by the “relaxed” mothers. The result: When the genetically “relaxed” strain baby mice underwent both their foetal stage and early stage of life with “anxious” strain mothers, they became as anxious as any other mice in that anxious strain. So were the mice’s abilities innate or learned? Was it the result of nature or nurture? Genes or environment?  It seems that environmental influences do not begin at or after birth; the environment seems to affect us even when we are in the womb – maybe the nutrition or stress levels of the mother affect the foetus. Also, relaxed strain mice are not relaxed only because of their genes but also because of their environment and nurturing practices that they are exposed to. Robert Sapolsky writes about this and other such studies that show the intertwining of genetics and environment in his book Monkeyluv: And Other Lessons in Our Lives as Animals.

 

Despite the retirement of “Nature versus Nurture,” both nature and nurture seem to conflate in some weird way in our parents. Choosing our parents wisely can either give us the benefit of both good genes and good environment or at least compensate for the deficiency of one. The worst is when I have parents with poor genes who also happen to be at the bottom of the socio-economic ladder. Galton would have called me the eugenic disaster. However, now that I am born, do I not deserve an opportunity to make good? This is what public health focuses on: to improve the circumstances of living for all, irrespective of their genes at birth. Perhaps Stallones was focusing our attention on the raison d’etre for public health when he said: Choose your parents wisely.

 

When it comes to Nature versus Nurture, an elementary error that we make in interpreting the effects of genes versus those of the environment is to assume that we can actually separate one from the other. The concept embodied in the phrase – Nature versus Nurture – has been criticized for its extreme simplification of very tightly interwoven parameters, as for example an environment of wealth, education, and social privilege are often historically passed to genetic offspring, even though wealth, education, and social privilege are not part of the human biological system, and so cannot be directly attributed to genetics.

 

However, most children inherit from their parents not only genes but also their environment. And it is our parents unfortunately who hold the key to both; majority of us are raised by the same parents who gave birth to us; very few are taken from their parents of birth and raised by someone else. So if I am born to poor parents, then I will obviously be raised in a poor environment too.

 

Parents from poor families not only have less money, less time and live in a poor stimulation environment, they also lack the necessary skills that will help them raise kids who can survive in a knowledge economy which demands very specific skill-sets of its employees. The findings of an interesting study conducted by researchers at the University of Kansas in the mid-1990s showed that children from higher income families had heard almost four times the number of words (2100) compared to children from low income families (600 words) even before they had joined the education system. Compared to children lower down the hierarchy, the ones from rich families get much more of a head-start?

 

My research on adoption of healthy lifestyle choices in eating and physical activity among families in Dallas found that low income parents were less likely to have changed undesirable, unhealthy behaviors. When asked why, the low-income families said they had the knowledge; they just did not have the time that is required for buying and cooking fresh food or for playing with children because all of them had two jobs. They needed two jobs because they could barely pay the rent or buy food with the income from one job. They ate fast food because with the very limited time they had for themselves, the food they ate had to be either cooked fast or made fast. Because most of their time is spent between workplaces, parents are tired when they return home, and have no time to engage with children, and are more likely to passively sit in front of a television than play with a child.

 

Far away from the shiny buildings in the city of Dallas with its wide open spaces to the urban slums of Mumbai with its traffic congestion and unclean clutter we found the same story repeating itself – in another language. “Eat less – Sleep less – Work more” – that is how a group of women from low income families in Mumbai described their daily lives in a study we conducted on food security among the urban poor.

 

Some people would then blame my poor upbringing on the poverty of my parents, the poor environment in which I grew up with minimal mental stimulation, some would blame it all on the poor genes and some would blame my continuing poverty on the poor parenting skills. Most of the times we get all this mixed up and we confuse income poverty with poor genes. Although the scientific argument against wealth  being seen as a biological attribute has been building up compared to  the days of Galton (when he may have mistaken wealth ownership as a sign of inheritable difference between people) – it seems that the tide has been turning in the past few decades. It seems we are going back to the days of Galton and eugenics. The more we have progressed in technology we have also regressed as a world. We have actually gone back to feudal times whereby wealth today has become an attribute of a very small percentage of people – the world is becoming one of widening and deepening inequality. It seems there is immense merit and wealth in store for us only if we choose our parents wisely; although these rich parents we would like to choose make up only 1% of the population.

 

The second event of 2014 that grabbed my attention was the English version of the book by Thomas Piketty

 

Inequality as a way of life – get used to it and stop protesting

 

Thomas Piketty, French economist and academician, published his nearly 700 page book Capital in the 21st century in 2013; however the English version hit the stands somewhere around the middle of 2014 and rapidly became a very important book. Despite the criticisms about his data and some of his conclusions, Piketty has ably re-ignited the debate about inequality in our time and also directed our collective attention to the lop-sided distribution of income and wealth. After extensively looking at data on wealth concentrations and distribution over the past 250 years, the book argues that the rate of returns to capital in developed countries is persistently greater than the rate of economic growth in those countries and this is leading to excess inequality. The benefit of returns to capital accrue to those who own that capital; higher economic growth may benefit to many other than those who started the economic or entrepreneurial initiative such as workers and smaller vendors due to rise in wages and greater distribution of wealth.

 Capital_in_the_Twenty-First_Century_(front_cover)

 

Europe was extremely unequal at the beginning of the industrial revolution in the 18th and 19th centuries. Few rich families had cornered most of the wealth; this often exceeded national income, and there was a rigid class structure. Despite the growth of industrialization contributing to increased wages of workers the form of inequality continued until the disruptive events of the two World Wars and the Great Depression. However, there was a brief period in which the growth of welfare states in Europe impacted wealth. There was a period of egalitarian distribution of wealth. However, in the past two to three decades of capitalism are seeing a regression; wealth is getting more concentrated in the hands of a few, according to Piketty, approaching the levels last seen before the world wars with rise in inequalities.

 

According to Piketty the general rule is that wealth grows faster than economic output. However, rapid economic growth can reduce the importance of wealth in a society, whereas slower growth allows wealth to dominate. Economic growth has slowed down in many European countries and stimuli for growth such as rising population or technological innovation do not seem to be around the corner. The consequence is the current wealth inequality. Piketty warns that our continuation with the status quo approach to economics and wealth will continue to see increased inequality in the future and its attendant political and economic upheavals. In order to address this problem, he proposes redistribution through a progressive global tax on wealth.

 

However, while being acclaimed as an economic classic, in my mind Piketty’s book may also be an example of a thought following a set of practices – rather than the other way around. People were already protesting – even before Capital was published – no one believed them. Only when Piketty published his book that experts said the protestors may be right. The book made the protestor’s valid. We seem to have drifted far away from Locke’s empirical school where experience told us everything we knew about the world. Piketty’s book and the attendant hoopla demonstrates that we, or at least our so called experts, no longer seem to believe in our people’s experiences. So much for the success of democracy, at least in the expert’s opinion.

 

Occupy Wall Street in New York City began on 17 September 2011 and was the first one to receive widespread attention was. By end of that year and before the release of the book Capital, Occupy protests had taken place in over 951 cities across 82 countries.

 

The Occupy movement protests against social and economic inequality around the world, its primary goal being to make the economic and political relations in all societies less vertically hierarchical and more flatly distributed. Local groups often have different focuses, but among the movement’s prime concerns deal with how large corporations and the global financial system control the world in a way that disproportionately benefits a minority, undermines democracy, and is unstable. It is part of what Manfred Steger has called the global justice movement.

 

We are the 99% is a political slogan widely used by the Occupy movement. The phrase directly refers to the concentration of income and wealth among the top earning 1%, and reflects an opinion that the “99%” are paying the price for the mistakes of a tiny minority within the upper class.

 

Inequality and health

 

That inequality is harmful for health has been known for some time. Some well-known researchers from United Kingdom such as Richard Wilkinson and Michael Marmot have been working on the social class distribution of disease and health as well as the effects of inequality on health (See Richard Wilkinson interview in The Essayist).

 

In 2009, Richard Wilkinson co-authored a book with Kate Pickett titled: The Spirit Level: Why More Equal Societies Almost Always Do Better. The book used data to demonstrate the toxic and unhealthy effects of inequality on societies including the erosion of trust, increased anxiety, illness, and encouraging excessive consumption. It demonstrated that those countries which had greater inequality (compared to those that had less) performed significantly poorly on each of eleven different health and social problems: physical health, mental health, drug abuse, education, imprisonment, obesity, social mobility, trust and community life, violence, teenage pregnancies, and child well-being, outcomes. Despite the criticisms, Wilkinson says that the evidence is there and we have to simply examine it dispassionately, In order to change society, one of the first things that has to happen is a change in our mind-set: We have to understand that we do not need inequality to thrive. We have to change the belief that we can grow only at the expense of others.

 

In an earlier book “Unhealthy Societies: The Afflictions of Inequality Wilkinson presented a body of evidence demonstrating that life expectancy is dramatically improved in countries where income differences are smaller and societies are more socially cohesive. Furthermore, the evidence, according to Wilkinson, was that social factors, rather than material ones, were the limiting component in quality of life in developed countries. The evidence suggested that what mattered within societies is not so much the direct health effects of absolute material living standards so much as the effects of social relativities. Health is powerfully affected by social position and by the scale of social and economic differences among the population. In terms of income, the relationship is with relative rather than absolute income levels. Wilkinson stated that the critical evidence for this relationship between relative income differences and health comes from strong international relationship between income distribution and national mortality rates. In the developed countries, it is not the richest countries that have the best health, but the most egalitarian.

 

There is a history to the study of inequalities on health in the United Kingdom. In 1977 the Research Working Group on Inequalities in Health was convened by David Ennals, Secretary of State for Social Services to study the relationship between social inequalities and health. The working group was chaired by Sir Douglas Black, president of the Royal College of Physicians; and hence the report that came from the working group’s findings was named the Black Report.

 

The central finding of the working group’s report (or Black report) was that there were large differences in mortality and disease between the social classes and these favoured the higher social classes; and most importantly these differences were not being redressed by health or social services. The Report showed the extent to which ill-health and death were unequally distributed among the population of Britain. It also suggested that inequalities were widening, rather than reducing, since the establishment of the National Health Service (NHS) in 1948. The Report concluded that these inequalities were not just due to problems with the health service (NHS), but due to various social differences influencing health such as inequalities in income, education, housing, diet, employment, and conditions of work.

 

The Black Report recommended various social policy measures to combat inequalities in health. However, these findings and recommendations were virtually disowned by the then Secretary of State for Social Services, very few copies of the Black Report were printed, and few people had the opportunity to read it.  However, the Whitehead Report published in 1987, Acheson Report in 1998, and the Marmot Review in 2010 came to the same conclusions as the Black report.

 

The Whitehall study findings also showed a clear link between income and health. The first Whitehall Study (Whitehall I) examined cardiovascular health outcomes in over 18,000 male civil servants, and was conducted over a period of ten years, beginning in 1967. It compared mortality of people in the highly stratified environment of the British Civil Service and found that mortality was higher among those in the lower grade when compared to the higher grade. The more senior one was in the employment hierarchy, the longer one might expect to live compared to people in lower employment grades.

 Edi 10_Richa N

 

Twenty years later, the Whitehall II study examined the health of 10,308 civil servants aged 35 to 55, of whom two thirds were men and one third women; and documented a similar gradient in morbidity in women as well as men. The Whitehall cohort studies consistently found a strong association between grade levels of civil servant employment and mortality rates from a range of causes. Men in the lowest grade (messengers, doorkeepers) had a mortality rate three times higher than that of men in the highest grade (administrators). While Whitehall I had focused on heart disease, the Whitehall II study revealed this social gradient for a range of different diseases: heart disease, some cancers, chronic lung disease, gastrointestinal disease, depression, suicide, sickness absence, back pain and general feelings of ill-health. A major challenge, and a reason for the importance of these studies, was to understand the causes of this kind of social distribution of so many disorders. Whitehall II also found that the way work is organised, the work climate, social influences outside work, influences from early life, and health behaviours all contribute to the social gradient in health.

 

So if inequality is getting institutionalized and entrenched in society, as Piketty argues, then what are the chances of a child who happens to choose poor parents? They are extremely poor because it seems that not only do people lower down in the socioeconomic hierarchy die earlier, and need help with their health, they also need help with parenting. Poor families are spiraling downward in a vicious cycle – less money, less resources – more work – less time – less understanding of what the economy demands – less skills imparted to children – children continue to stay lower down in the hierarchy – more inequality.

 

Can inequality and its effects on health be addressed by choosing one’s parents wisely? In a world of growing inequality, all the unborn children would want to choose the top 1% of the population. No way out.

 

History teaches us nothing. It simply recycles power.

 

“People with advantages are loath to believe that they just happen to be people with advantages.” 
― C. Wright Mills

 

If the only history we have are nothing but the biographies of famous people – rich people – the winners, then we have a history that erases the existence of billions. We have a history that behaves as if the so-called losers do not exist. The losers are invisible when in reality the losers make up the multitudes. Only one in a million becomes a king or a billionaire or a military general. We read about Napoleon and JP Morgan and Steve Jobs? What about the peasant who was forced to fight a war to fulfil Napoleon’s desire to be an Emperor or the accountant who lost his family life and did not get to enjoy his children’s childhood because JP Morgan willed himself into the richest man in the world.

 

Biographies are positioned as works of non-fiction, which means that the writer or the publishing company or the powers-that-be are trying to say that “This is the truth. This is what happened, believe me because I am rich and famous.” And we believe him? We do not ask, what made you rich and famous in the first place

 

Professor Hermione Lee who has written extensively on women writers and is author of a collection of essays on biography and autobiography: Body Parts: Essays on Life-Writing (2005) argues that all history is seen through a perspective that is the product of our contemporary society and as a result biographical truths are constantly shifting. So the history biographers write about will not be the way that it happened; it will be the way they remembered it.

 

How does a person remember something? Is his or her memory not coloured with their own subjective biases? Now that makes history and the truth a product of how a person perceived it? History, then, in reality becomes perception and not the fact it is sold to be. History becomes a vehicle to re-cycle the notion of power and advantage – to continue with the same old idea that you have to be born with great talent in order to become great. There are certain kinds of people who write their biographies.

 

In 1936, Carl Sandburg published a book of verses titled The People, Yes. A small piece from that artfully uncovers the assumptions underlying property and power.

 

“Get off my estate.”

“What for?”

 

“Because it’s mine.”

“Where did you get it?”

 

“From my father.”

“Where did he get it?”

 

“From his father.”

“And where did he get it?”

 

“He fought for it.”

“Well, I’ll fight you for it.”

 

Benjamin Barber cites this Carl Sandburg poem in his 2004 book “Strong Democracy: Participatory Politics for a New Age” to demonstrate the underlying similarity between claim and force. Barber argues that property and its acquisition is simply the logical culmination of power-seeking. He sees no difference between property and power; rather that property is simply the long-term avatar of power. He argues:

 

Property is a form of cumulative power, an authoritative variety of institutionalized aggression, by which the claims of individuals to adequate means are given a permanent and logical home. Raw power provides temporary control while property possession lends to coercion over time enhancing the effect of power by diminishing the need for its perpetual exercise.

 

All of us take our resources from the environment. Those who do not own property or land have to beg borrow, buy whereas those who own land only have to protect and use and at much less risk. Property provides the sense of certainty over the much needed resources that humans need for their daily life and survival. Land ownership and its use takes away the edge of daily survival and the constant battle that the poor wage against their own needs and the economy and society that controls it. Because of this it seems that those with property, the wealthy are not really fighting this daily battle for survival. They seem like the winners and they seem like the fittest in the human species because they are perceived as being above the laws of survival.

 

However, little do these arguments recognize that wealth is not a biological attribute of the species. Wealth is temporary when seen in terms of timeline of the human species.  And many times wealth has been claimed by brute force. The colonization of many parts of the world – Asia, Africa, Latin America is a case in point where those with guns outnumbered those with spears and claimed moral and intellectual racial superiority just because they were more willing to exercise violence than the subjugated races. The oppressor and the violent wrote the history of evolution and its theories.

 

Wealth is not a differentiator of inherited differences between people; beneath the so called superiority of property and wealth lies the dark history of brute force. As Carl Sandburg reminds us that even if we were to choose parents who are wealthy we may lose it all to the brute force of someone wielding greater raw power than us. It may get stolen or taken from us.

 

*****

Pushing the thought of choosing one’s parents wisely further and thinking of biographies as history, what would be the content of the biography of a child to be born in 2015. How many children born in 2015 would say that they chose their parents wisely? And how many would say the opposite?  I wondered what an unborn child would wonder as she looked at our world, especially events three and four of 2014: the rise in the market and business of cord blood and the UN sustainable development goals -

 

Cord Blood: The baby saves the parents

 

In November 2014, Research and Markets announced the release of the “Complete 2015-16 Global Cord Blood Banking Industry Report.” The global stem cell market is currently dominating the healthcare industry; current market for cord blood therapeutics accounts for US$ 6.5 billion, and expected to grow at 33.4% year over year from 2013-2020 (although some argue that growth rates will be lower). Research on stem cells continues to advance knowledge about how an organism develops from a single cell and how healthy cells replace damaged cells in adult organisms. Stem cell research has become both a fascinating area of research for contemporary biology, and also the new frontier for medical technology and marketing the magic of medicine (through a renewed focus on regenerative therapies). Everyone wants to live forever…and the umbilical cord seems to be the way to get there.

 

The baby is connected to the mother’s womb through the placenta; which allows the baby to absorb nutrients from the mother, eliminate waste products and also exchange gases. The placenta is the life support system for the foetus in the womb.  After the delivery or birth of a baby, the placenta, also known as after-birth, is expelled by the mother’s body usually within 15 to 30 minutes. However, some blood remains in the blood vessels of the placenta and the portion of the umbilical cord that remains attached to it. This blood is called placental blood, umbilical cord blood or popularly known as “cord blood.” In addition to the usual components of blood such as red blood cells, white blood cells and platelets, cord blood is rich in hematopoietic (blood-forming) stem cells, similar to those found in bone marrow. It is the presence of these stem cells that have made umbilical cord blood a business commodity and given a boost to the regenerative medicine industry as well.

 

When a stem cell divides, each new cell has the potential either to remain a stem cell or become another type of cell with a more specialized function, such as a muscle cell, a red blood cell, or a brain cell. Stem cells have the potential to develop into many different cell types in the body during early life and growth. In addition, in many tissues they serve as a sort of internal repair system, dividing essentially without limit to replenish other cells as long as the person or animal is alive. The presence of these stem cells makes cord blood useful. Cord blood is being used increasingly on an experimental basis as a source of stem cells, and as an alternative to bone marrow. Most cord blood transplants have been performed in patients with blood and immune system diseases; and for some patients with genetic or metabolic diseases.

 

According to the National Institutes of Health (NIH) perhaps the most important potential application of human stem cells is the generation of cells and tissues that could be used for cell-based therapies. Today, donated organs and tissues are often used to replace diseased or destroyed tissue, but the need for transplant (tissues and organs) is much higher than what is available today. Encouraging people to donate organs, while alive or after death, is one way of reducing this gap. However, stem cells, directed to differentiate into specific cell types, offer the possibility of a renewable source of replacement cells and tissues to treat diseases including macular degeneration, spinal cord injury, stroke, burns, heart disease, diabetes, osteoarthritis, and rheumatoid arthritis. Scientists are investigating the possibility that stem cells in cord blood may be able to replace cells of other tissues such as nerve or heart cells.

Thus, given the volume of business and expected growth of the market as mentioned above, private cord blood companies and banks have mushroomed. According to a report on the industry released in 2010, the cord blood bank market is divided into two segments, public and private: “Public banks receive donations for the benefit of all and once a donation is deposited in the bank the specimen loses its identity and is not attributed to the donor. On the other hand, in private family banks process is being paid for by the family and the cord blood unit collected belongs to the baby for its own use, or for applications in family members if needed. In terms of cord blood currently in storage, there are approximately 3 million cord blood units currently stored with over 80% in private banks.”

 

The sales-persons for these cord blood companies (and banks) approach the pregnant woman / couple asking them to save cord blood in their company banks for a certain period of time; and of course for a substantial fee. These companies sell the benefits of cord blood for the future health of the child (they can fight any disease) as well as for other family members, who may become sick and need stem cell therapies.

 

Often these commercial cord blood companies and banks offer personal storage of cord blood to families with no known genetic risk of disease. There may not even be the history of genetic conditions that can be treated with stem cell (cord blood) given our state of current knowledge. Parents who buy the cord blood promise buy it because they are now given an option or imagine possibility – what if there is an event that a child of such a family spontaneously develops a medical condition that might be treated using cord blood? What will you do then? Why not save it now for a small fee than undergo the guilt and shame later? Be a wise parent they are told. Choose the option of buying a refrigerator space for your cord blood (even though none of your family members have a history of genetic disease).

thank you mom for securing my life

 

They are even sold the idea that the saved cord blood and the stem cells within can help other family members if they develop a disease.

 

In July 2006, the Royal College of Obstetricians and Gynecologists (RCOG) released a report on the uses and the potential perils of umbilical cord blood collection. The findings of the RCOG report led them to conclude that directed cord blood donation in low‐risk families is at present likely to be of little use, and that the probability of using a directed donation is sufficiently low to fail to justify the procedure’s expense. Although they support public funding for non‐directed donation as a community health resource and for directed donation where indicated by genetic risk factors, their view is that directed donation in the case of families who are not at risk is of dubious utility and should not be funded. The practice of commercial cord blood banking for directed storage is therefore not recommended, although (as opposed to policy in some countries) they advise that it should be permitted as a matter of choice.

 

Since the 1990s, many countries have established national bioethics committees or commissions. The opinions from the different Committees are fundamentally unanimous in their evaluations: Private, single family based cord blood storage is of low or no value.

 protect your family cord blood cordlife

 

The French Comité Consultatif National d’Éthique pour les Sciences de la Vie et de la Santé finds that such banks disguise a mercantile project using assistance to children as a screen. However, they say the gravest danger is for society in so far as setting up such banks is likely to contradict the principle of solidarity, without which no society can survive. These banks jeopardize justice and equity. If any reasonable indications existed, then the offer should be systematic, organised, managed, and supervised by public authorities; cost and broadness of scale then enter the picture. The disproportionate, and for the time being useless, cost of generalised autologous storage is in total contradiction with the obligation to provide public health based on solidarity and awareness of priorities. Management by the private sector may be seen as discrimination based on wealth. However, this would hardly be exceptional in the healthcare sector, and those who use these programmes cannot be blamed for their ingenuousness.

 

Parents hang on to the idea that they should do everything they can for the benefit of their children. They do not want to miss any tree in the forest of ‘what can be done’ when it comes to giving their children a better life. However, in looking at each tree that will bring happiness in their child’s life, many parents miss out on the forest. While each parent is focused on individual things that can be done, the environment in which their children will live in the future is being decimated. Parents are not looking at the world while trying to ensure their child has the best that this world has to offer. They are busy looking at the offerings on display without realizing that the ground they stand on is becoming inhospitable for human life each day. When someone says: The world may not have a clean air and water to offer soon. The parents reply: But we have saved cord blood instead?

 

Maybe we cannot choose our parents wisely or choose them at all; however, we can choose the world we choose to live in, wisely!

 

The state of our world and planet demands that we make a choice about what kind of world we inhabit. We have to change our habits in order to make this world a habitable place again.

 

UN Sustainable Development Goals (SDGs)

 

The UN Open Working Group on Sustainable Development Goals submitted their proposal for SGD goals to the UN Assembly sometime in the mid of 2014. The proposal contains 17 goals with 169 targets covering a broad range of sustainable development issues, including making cities more sustainable, combating climate change, and protecting oceans and forests

 

This was one of the outcomes of the Rio+20 Conference in 2012 (hosted in Rio de Janeiro, Brazil) which saw participation from 192 UN member states — including 57 Heads of State and 31 Heads of Government, private sector companies, NGOs and other groups.

 

Member States agreed to launch a process to develop a set of Sustainable Development Goals (SDGs), through the Rio+20 outcome document, “The Future We Want”, which also called for the goals to be integrated into the UN’s post-2015 Development Agenda.

 

In 1992, the first United Nations Conference on Environment and Development (UNCED), referred to as the Rio Conference or Earth Summit, succeeded in raising public awareness of the need to integrate environment and development. Ten years later, Earth Summit 2002, informally termed Rio+10 was held in Johannesburg, South Africa with the goal of bringing the world together to create a green economy. At Rio+10, sustainable development was recognized as an overarching goal for institutions at the national, regional and international levels. Rio+20 was a 20-year follow-up to the 1992 Earth Summit. Green economy roadmap discussions were pushed aside for sustainable development goals with focus on the economy more than the environment. The word sustainable is used politically to mask the lack of an all-out effort to go completely green.

 

The current development agenda, until 2015, is centred on the Millennium Development Goals (MDGs) that were officially established following the Millennium Summit of the United Nations (UN) in 2000. The MDGs encapsulate eight globally agreed goals in the areas of poverty alleviation, education, gender equality and empowerment of women, child and maternal health, reducing HIV/AIDS and communicable diseases. Environmental sustainability was one among eight. The difference in the SDG is that almost all the 17 goals talk about sustainable practices, mentioned income inequality eradication as a goal and almost 13 of the 17 (working) goals have use the word sustainable, climate change, quality of environment have all found mentions. Although removal of poverty remains the central preoccupation, the word environment is not mentioned, however some environmental concerns are addressed with greater mention using the term – sustainability or under the catch-all notion of – health. The UN still shies away from directly tacking air pollution – one of the biggest problems facing human kind and a major contributor to disease and mortality. It subsumes air quality under heath goals rather than making air quality the goal.

 

air pollution

 

On June 13, 2014, the Global Alliance on Health and Pollution (GAHP) released a report, whose analysis was based on new data from the World Health Organization (WHO) and others. It clearly blamed pollution as the cause of more than 8.4 million deaths (annually) in the developing world – of which 7.4 million deaths were due to pollution sources from air, water, sanitation and hygiene.  WHO figures released in May 2014 counted deaths from outdoor and indoor air pollution at 6.58 million; water contamination, lack of sanitation and hygiene at 842,000. An additional 1 million deaths were attributed to toxic chemical and industrial wastes from large and small producers in formal and informal sectors of developing economies.

 

Despite pollution being the largest contributor to diseases and deaths, it still remains low priority in the current draft of the Sustainable Development Goals (SDG), In fact, pollution was said to cause causes almost three times more deaths than malaria, HIV/AIDS and tuberculosis combined (1.5 million deaths from HIV; 600,000 from malaria; and 900,000 from tuberculosis).

 

If we do not have air to breathe, how will we have the life to see growth and prosperity in our nations? It seems that the UN is so desperately trying to fight poverty, that it has become impoverished in its own thinking. The truth is that the UN does not want to displease anyone – neither the poor nations nor the rich and especially the masters who pay for having conferences in exotic places and hotels – the corporations. The economy of our society is just a euphemistic word for our slothfulness of thinking and inability to conceive of change (see article in this isssue: Is There No Alternative?). If a United Nations declaration reflects the state of our world and our collective thought process, then it shows an absolute inability to think. It seems all this poor quality air and water has also affected the brains of our global experts. Or is this the affliction of our time – the inability to think of an alternative way of life?

 

What would the unborn children think as they looked at our world? Here are our future parents, who are happily paying money to store cord blood in banks so that we can fight disease, degeneration,  live long lives while being mute spectators to the complete devastation of the very air we will breathe when we cry for the first time?  Perhaps, our unborn children will stop crying…what is they point, they ask?

 

Now…Choose your world wisely – Resolve our relational issues

 

Choose your parents wisely – the statement by Reuel Stallones then become a lens to look at our world and to analyse and frame the problem of health and highlights how it is disproportionately distributed in society. However it does not provide an easily approachable springboard for action. The levers of change in choosing parents seem to either be huge government actions in terms of supporting the dispossessed, or it puts a disproportionate share of the responsibility on parents and parenting, especially those in the lower rungs who are already ill-equipped.

 

How do we create a better world – an enlightened world – better still, a wise world?

 

Choose your parents wisely – definitely helps to highlight the issue of injustice wrought on (wo)man – whether by Nature or by her own Society. Rule number 1: Choose your parents wisely brings us to a certain point in our understanding of the world and perhaps then pushes us to look for avenues of action. It forces me to think of Rule number 2, perhaps something that Stallones had in mind: Choose your world wisely.

 

Looking forward (from 2015) into the evolution of our world, there seems to be two major relational issues that need resolution. Not only is there a rot in the way we relate to each other, diseases or problems seem to be distributed disproportionately among those lower down in the social hierarchy and inequalities are becoming entrenched; but also a rupture in the way we relate to our environment, as seen in the rapid deterioration of air quality.

 

How do we resolve this? How do we get better health for all as a sign that our society is indeed civilized? There are two aspects: one is a better appreciation of social justice and action on injustice, and re-frame the notion of choice.

 

There is injustice all around us.

 

Although everyone understands injustice, especially when it is perceived as happening to themselves, and popular culture and film thrives on the whole idea of redress of injustice; very few actually know how to ensure justice in society.

 

Justice is an abstract concept. Every group distributes or imposes its share of benefits and burdens on the members. Justice, in shorthand, is the correct and proper allocation of the fair share of collective burdens and benefits to all members of a group or society. The benefits to be distributed usually include income, education, opportunities, social status, or even happiness. The burdens usually mean taxation, social reservations or even certain restrictions on certain individual actions. Fairness in the distribution of benefits and burdens is justice. On the other hand, injustices are reported when some individuals are denied a particular benefit or when some individuals feel that they a burden is being imposed unduly on their shoulders. If access to health services or even being healthy or living long is considered to be a benefit (or if poor health is considered to be a burden), then the linkage between the concept of justice and the practice of public health become clear.

 

It is clear that poor genes may affect a person poorly and we think that we cannot do anything about Nature. So we decide to fight against this perceived injustice of Nature – which gave us bad genes – by storing cord blood and ensuring that this cord blood, thanks to expected advances in medical technology, can be used in the future to rectify this individual injustice. However, health policy, which often considers Nature to be a given, should be more concerned in doing something at a larger population or social level. Therefore, it turns to Nurture. Can we somehow eliminate those factors that create inequalities and are social or cultural in origin?

 

This is in contrast to the eugenics of the time of Francis Galton, which tried to propose practices to improve the genetic quality of the human population, and became a social philosophy that strongly advocated promotion of higher reproduction of people with desired traits (positive eugenics) and reduced reproduction of people with undesired traits (negative eugenics) for overall improvement in the pool of human genetic traits. Post-World war 2, eugenics became obviously unpopular.

 

Joshua Lederberg, winner of the 1958 Nobel prize in Physiology or Medicine when he was just 33 years old, coined the term eu-phenics, to differentiate the practice from eugenics, and to highlight that genetic manipulations could work on the phenotype rather than the genotype. Ledeeberg argued that one could more positively change an individual’s genetics rather than attempt to change the course of evolution as eugenics proposed. A positive form of genetic engineering that is used extensively by the medical and health policy community to refer to methods of affecting a genetic condition in a positive manner through diet, lifestyle or environment, such as the use of insulin to control diabetes or installation of a pacemaker to offset a heart defect. The 1970s saw one of publicized application of the notion of euphenics when folic acid was given to pregnant women to combat neural-tube deficiencies such as spina bifida in the babies.

 

Thus, saving cord blood for future use may be one hopeful method for a parent to demonstrate to their child that her or his parents were thoughtful; to reassure the child that you chose your parents wisely. However, like any individual method at rectifying greater problems that we face as a society, it falls terribly short. If the air quality continues to deteriorate at this pace, then no amount of cord blood will be able to save our children.  We are ultimately part of our environment and it is our environment that determines our health. By acting on our individual bodies we can only advance to a limited extent and help a limited number of people. However, acting on the environment greatly improves the chances and opportunities to be healthy for a much greater number of people.

 

Social justice is said to be a foundation of public health and also the underpinning of the rights-based approach to health, food, clean air and many other essential aspects of human survival. What does it mean then to argue on the basis of social justice?

 

Social justice proponents argue that significant factors within a society impede the fair distribution of benefits and burdens. Examples of impediments include poverty, lack of educational opportunities, gender, age, social class distinctions, racism, caste, and ethnic differences.

 

The social justice argument sees public health as a public matter. The results of public actions such as death rates, disease occurrences, health, and well-being are said to reflect the decisions and actions that a society makes. For instance, high rates of maternal deaths in some countries, which are death rates among women in their fertile years, can be seen as a gender issue. On the other hand, that maternal mortality rates may be higher among low income groups that middle- or high-income groups becomes a social class issue. The goal of extending the benefits of the fruits of medical and behavioral sciences to all groups in the society, especially when the burden of disease and ill health within that society is unequally distributed, is largely based on the principles of social justice.

 

It is clear that many modern public health (and other public policy) problems disproportionately affect some groups, usually a minority of the population, more than others. As a result, their resolution requires collective actions in which those less affected take on greater burdens, while not commensurately benefiting from those actions. When the necessary collective actions are not taken, even the most important public policy problems remain unsolved, despite periodically becoming highly visible.

 

A critical challenge for public health as a social enterprise lies in overcoming the social and ethical barriers that prevent us from doing more with tools already available to us (see Beauchamp, 1976). Extending the frontiers of science and knowledge may not be as useful for improving public health as shifting the collective values of our society to act on what we already know. Recent public health successes, such as reduced smoking in both public and private locations and in episodes of drunk-driving provide supportive evidence for this school of thought. It was not a newer, bigger invention or technology that changed practice and reduced mortality rates drastically; rather it was mere change in our social norms. And how we collectively saw it as a problem worthy of our attention, our time and our desire for action?

 

Perhaps what will help the UN reach the desired sustainable development goals are simple changes in ideation – the way we think, our social norms, our consumer and daily habits, how we relate to the environment and what we do every day that will make the biggest difference in the improved environmental quality.

 

Choosing the right choice – Choosing a world wisely

We live in a box of limitless possibilities… all of which are greatly limiting our ability to continue to live on the planet.

 

“Freedom is not merely the opportunity to do as one pleases; neither is it merely the opportunity to choose between set alternatives. Freedom is, first of all, the chance to formulate the available choices, to argue over them — and then, the opportunity to choose.”

― C. Wright Mills

 

 

Many of us may not completely agree with the statement: Greed is good. This seems especially true today given the recent recession and that more of us are aware and somewhat angry that the super-rich 1% controls the lives of the rest of us in the 99%.

 

But despite all the protesting, at the end of the day, almost all of us agree that: Choice is good.

 

We live in a world where the word ‘choice’ has become synonymous with our time. It is our way of life. Everyone needs choices. It is now considered a basic human need like air, water, shelter. No choice is considered restrictive and a sign that either the individual does not have enough freedom or the society is not developed (or civilized) enough. On the other hand, what we also experience at a personal level is the availability of too many choices. How many times have we stood paralyzed in front a fast food counter – unable to make a choice as to what we want to order to eat or drink? What kind of coffee, what do we want on the side and so on? How many accessories to buy with our clothes?

 

Choice is defined in the dictionary as a noun which means simply the act of choosing between two possibilities. Choice implies action. However choice essentially means first arriving at a decision. When one makes a choice, one judges the merits of multiple options and selects one of them (sometimes more than one).

 

Bill Simon, eminent sociologist, intellectual, friend and mentor who co-authored (with John Gagnon) the book, Sexual Conduct: The Social Sources of Human Conduct which pioneered the theory of sexual scripting, used to comment: At no other time in human history did a human being wake up in the morning, open his closet, look at his wardrobe which consists of thousands of apparel, and ask himself or herself the question: What do I choose to be today? The choice of objects and consumer goods had extended itself into the consciousness. We are making so many choices that we even choose our personality for the day or sometime for a particular time of the day. I will be conscientious co-worker who looks like a librarian and in the evening I will morph into sexy siren. All in a day’s work. What am I? I am not sure so I will keep choosing and I am sure I will find out soon.

 

Many choices may seem simple. On a day to day basis city dwellers constantly make choices: what do I eat for lunch today? There are many choices in the food court? Or which route do I take to work today – the bus, subway, taxi or walk? Complex choices such as choosing a partner or a career path can lead to making choices between imagined options (what would happen if …?) followed by the corresponding action. In these complex situations, making a choice may mean the mixing up of cognition, instinct and emotion.

 

Complex choices are also often associated with regret, of the alternatives not taken, the road not taken, the partner not chosen. The blame of making a choice that did not work out in our favour often leads to self-blame. Making a choice of an object or of a course of action can also lead to an illusion that we can control that object or course of action. The best example we have right now are two paths chosen by our world and us collectively because we participate in it every day: one is the capitalist path towards development and progress where money and the making of more money has become the supreme choice; and the path of using environmental resources for human comfort and convenience.

 

Capitalism is one among many historical methods of running a planet. It was one choice among many; considered the better among many options to create and distribute wealth. However, the presence of 99% of young and old protestors in almost all parts of the world from New York to Hong Kong shouting against the tyranny of a world where youth continue to be unemployed so that !% of the owners of corporations can remain rich and powerful.

 

On the other hand the recognition by United Nations that improving air and water quality is the most important goal for the planet is also a recognition of the magnitude of what we have done to our planet. We made some choices as a society. We chose to give our personal and planetary destiny into the hands of few corporations and now it seems our choices have spiralled out of our control and now perhaps seek to destroy us, yet we continue to behave as if it is business as usual.

 

The realization that choice does not necessarily mean control can cause mental distress. And so we do not want to accept this realization; we continue to build stories of how our choice will ultimately lead to control and a better world. We continue to live in denial. And our experts in the popular media help maintain it. We are exhorted to continue to party.

 

Our choices are restricted to choosing attire at a mall or a partner from a dating site. We forget that we are given a box, limited in size, and then the illusion of unending choices within that box. They tell us: You live in a box of limitless possibilities. We are so happy searching for choices within that box that we never look up or outside. We forget that we are in a box that is part of a set of increasingly larger sized boxes, one outside the other. In terms of choice we are happy to make choices within our box or at best happy to reach out into the box that is at the next level. However we rarely look at the world from the outside in and see that in terms of our lifestyle we really do not have any choice except to be part of this system that worships money and desecrates the planet. In that sense, we are boxed in.  So we have to keep choosing. We do not have the choice to NOT make any choices.

 

“O con noi o contro di noi”

(You’re either with us or against us.)

attributed to Benito Mussolini in speeches across fascist Italy

 

Zygmunt Bauman in his book Liquid Times: Living in an Age of Uncertainty (2007) argues that in our age (which he calls the age of liquid modernity) all the burdens of benefits of one’s own life, its successes and failures, its victories and misfortunes, now falls back upon the individual who has no one else to blame than himself or herself. Society no longer takes any responsibility – it is now all up to you. He laments the dissolution of ‘society’ and ‘the social’, which is now increasingly deregulated, privatized and individualized. Bauman comments that living in a liquid-modern society is like being on board a flight where all the passengers are painfully aware that the pilot – those in control – has long since evacuated the cockpit and that the plane is set on a crash course.  (also see article titled ‘ Is there No Alternative? by Michael Jacobsen in The Essayist). So, in such a society, if you cannot choose your parents wisely, then it’s all your fault. In a culture where impossible has become “i’m possible,” it will be no wonder if soon we see billboards screaming from rooftops: Go ahead, choose your parents. Just do it.

 

“Our society has stopped questioning itself – where it comes from, how it got to where it is now, how it may become different from what it currently is and where it is headed? One of the paradoxical consequences of all the progress and rapid changes of the past is that today society seems more and more resistant to change or self-critique. This situation has made Zygmunt Bauman proclaim the prevalence of the so-called ‘TINA Syndrome’. TINA is the acronym for: ‘There Is No Alternative’ (originally attributed to British Prime Minister Margaret Thatcher). Bauman finds that the world today has altogether forgotten that it can be made and re-made in another way by men and women and therefore people live their lives as if this is the only world possible. Such a world thinks of itself as the best of all possible worlds:

 

‘Our form of life’ has once and for all proved both its viability and its superiority over any other real or imaginable form, our mixture of individual freedom and consumer market has emerged as the necessary and sufficient, truly universal principle of social organization, there will be no more traumatic turns in history, indeed no history to speak of. For ‘our way of life’ the world has become a safe place.”

-          Zygmunt Bauman

 

No one wants to change a ‘safe place.’ Now this assumption becomes especially dangerous given that our environmental quality is rapidly deteriorating. The United Nations has acknowledged this but we have not because society seems to be hurtling down the same old path. The quality of air is so poor in some places that the babies of tomorrow will refuse to cry when they are born.

 

But a world whose thinking is ruled by the “TINA” Syndrome refuses to talk about an alternative future. It refuses to acknowledge that we may need to choose a different way of living. In a world of limitless choices we seem to be unable to make that one important choice that will determine our future and the future of all our babies. A choice that will make these babies proud that they indeed chose their parents wisely because the parents decided to – Choose their world wisely.

 

Aren’t we creatures with agency? We can act. We can choose. We can act in different ways – some make the world a better place for our children and some do not. Today we stand at that intersection. We have to make that choice, howsoever heard that choice may be. A choice that may tear us apart, take away some of our comforts and most of our conveniences. However, we do have to go back to Galton and Darwin and think about the future of the species. Parents are the ones who give birth to the next generation of the species. So it is for all those who are parents or want to be parents to think, act, and make that choice: Do I want my child to say: I chose my parents wisely? And not because I was clever and put away some cord blood in a freezer or money in a bank. But, because I made the choices which demonstrate that I chose my world wisely. I made it safer to breathe, drink, eat and walk in; I ensured that every child had opportunity.

 

However, imagine that yet unborn child, wherever she is right now, and see the world from her perspective. For her, the chances of  choosing parents wisely seems more realistic than the chance of choosing a world that is wise.

 

In that sense the events of 2014 and the teaching technique of Reuel Stallones should make us all into the best public health practitioners. We do not need a degree to practice it. We do so by virtue of being a person of this planet, who makes informed choices. We choose to think.

 

“Let every man be his own methodologist, let every man be his own theorist.”

― C. Wright Mills, The Sociological Imagination

 

 

*****

© Nilesh Chatterjee, 2015

 

 

Bibliography:

 

Reuel Stallones

  • William J. Schull and Darwin R. Labarthe (1986). Reuel A. Stallones: In Memoriam. Genetic Epidemiology 3:381-384 (1986).

 

Francis Galton and Nature vs Nurture

  • http://galton.org/start.html
  • http://www.todayinsci.com/G/Galton_Francis/GaltonFrancis-Quotations.htm
  • http://www.brainsturbator.com/posts/197/the-wit-and-wisdom-of-sir-francis-galton
  • http://en.wikiquote.org/wiki/Francis_Galton
  • Image of Sir Francis galton: http://en.wikiquote.org/wiki/File:Francis_Galton_1850s.jpg
  • Image of Charles Darwin: http://en.wikiquote.org/wiki/File:Charles_Darwin.jpg

 

Beyond Nature and Nurture

  • Darlene D. Francis, Kathleen Szegda, Gregory Campbell, W. David Martin & Thomas R. Insel. Epigenetic sources of behavioral differences in mice. Nature Neuroscience 6, 445 – 446 (2003). Published online: 31 March 2003 | doi:10.1038/nn1038
  • Darlene Francis and Daniela Kaufer. Beyond Nature vs. Nurture. The Scientist. October 1, 2011. http://www.the-scientist.com/?articles.view/articleNo/31233/title/Beyond-Nature-vs–Nurture/
  • Robert M Sapolsky. Monkeyluv: And Other Lessons in Our Lives as Animals.  Vintage Books, 2006.

 

Edge.org

  • John Brockman (editor) (2015). This Idea Must Die: Scientific Theories that Are Blocking Progress. Harper Perennial (February 17, 2015)
  • http://edge.org/annual-question/what-scientific-idea-is-ready-for-retirement
  • http://edge.org/response-detail/25365
  • Luci Gutiérrez. Time to Retire The Simplicity of Nature vs. Nurture. http://www.wsj.com/articles/SB10001424052702304302704579334954138196792

 

Using oppositions

  • Berger AA. Cultural Criticism: A Primer of Key Concepts. London:Sage, 1995.
  • Durkheim E. The elementary forms of religious life. New York:Free Press, 1967.
  • Saussure F de. A course in general linguistics (W. Baskin, Trans).

 

Inequality and Health

  • Kate Pickett and Richard Wilkinson. The Spirit Level: Why Equality is Better for Everyone. Penguin (November 4, 2010).
  • Richard Wilkinson. Unhealthy Societies: The Afflictions of Inequality. Routledge; 1 edition (November 21, 1996).

 

Cord blood and Stem cells

  • Amnon Pelz. Stem Cell Preservation and Insurance Coverage: Combining Business Leverage for the Stem Cell Industry and New Opportunities in Biobanking. World Stem Cell Report 2009. Genetics Policy Institute  2010 World Stem Cell Summit, Detroit, MI, Oct 4-6, 2010, www.worldstemcellsummit.com  • www.genpol.org
  • http://stemcells.nih.gov/info/basics/pages/basics1.aspx
  • http://stemcells.nih.gov/info/basics/pages/basics6.aspx
  • Global Stem Cell Umbilical Cord Blood (UCB) Market (Storage Service, Therapeutics, Application, Geography) – Size, Share, Global Trends, Analysis, Opportunities, Growth, Intelligence and Forecast, 2012 – 2020
  • http://www.marketwatch.com/story/global-stem-cell-umbilical-cord-blood-ucb-market-storage-service-therapeutics-application-geography-size-share-global-trends-analysis-opportunities-growth-intelligence-and-forecast-2012-2020-2014-04-23
  •  MarketResearch.com: Cord Blood Industry 2015-16 Report Reveals Changing Industry Dynamics http://www.cnbc.com/id/102312691#.
  •  National Cord Blood Program – http://www.nationalcordbloodprogram.org/qa/
  •  Royal College of Obstetricians and Gynaecologists (RCOG) Umbilical cord blood banking: Scientific Advisory Committee opinion, Paper 2. London: Royal College of Obstetricians and Gynaecologists, 2006
  •  S Chan. Cord blood banking: what are the real issues? J Med Ethics. Nov 2006; 32(11): 621–622.
  •  Comité Consultatif National d’Éthique pour les Sciences de la Vie et de la Santé (CCNE): Avis 74 – Les banques de sang de cordon ombilical en vue d’une utilisation autologue ou en recherche. 12 December 2002. www.ccne-ethique.fr/docs/fr/avis074.pdf (Accessed: 15 November 2009).
  •  Cameron L Stewart, Lorena C Aparicio and Ian H Kerridge. Ethical and legal issues raised by cord blood banking — the challenges of the new bioeconomy. Medical Journal of Australia 2013; 199 (4): 290-292.
  • Research and Markets.”Complete 2015-16 Global Cord Blood Banking Industry Report.”  http://www.researchandmarkets.com/research/qw8d5p/complete_20151

 

Sustainable Development

  • Open Working group on Sustainable Development Goals https://sustainabledevelopment.un.org/?menu=1300
  • Open Working Group proposal for Sustainable development Goals https://drive.google.com/viewerng/viewer?url=http://sustainabledevelopment.un.org/content/documents/1579SDGs+Proposal.pdf&embedded=true
  •  Global Alliance on health and Pollution – http://www.gahp.net/new/press-release-sdgs/

 

Social Justice

  • Afifi, AA and L Breslow. The maturing paradigm of public health. Annual Review of Public Health, 1994, 15, 223-235.
  • Beachamp, DE. Public health as social justice. Inquiry, 1976, 13, 1, 3-14.
  • Bunker, JP, HS Frazier, and F. Mosteller. Improving health: Measuring effects of medical care. Milbank Quarterly, 1994, 72, 225-258.
  • Harris polls. Public Opinion about Public Health, United States. 1999.
  • Susser, M. Health as a human right: An epidemiologist’s perspective on public health. American Journal of Public Health, 1993, 83, 418-426.
  • Turnock, BJ. Public Health: What It Is and How It Works. Second edition. Gaithersburg, Maryland:Aspen, 2001.
  •  Bauman, Zygmunt (2007): Liquid Times: Living in an Age of Uncertainty. Cambridge: Polity Press.

 

Image Credits

Old Playhouse Close, Edinburgh by Richa Narvekar

 


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