Psychosocial Stress and CVD

It seems like eons that I have been trying to write a blog post that discusses how social factors influence health without losing the depth and complexity of the issue. Recently, I made a simple short status update on Facebook about psychosocial stress and cardiovascular disease(CVD). Quickly, some of my friends from all corners of the US chimed in and enriched my understanding of the topic. I then sat down trying to write another post after being influenced by all of my friend's input. Soon, I realized that this discussion took a more organic approach; similar to that of a grad seminar session, and it was already captured in print. After getting the permission of all but one of my friends/contributors, I posted it. I am so thankful to have such curious friends who love to engage in these types of deep discussions.


Chris Aloia:
Doing a lot of reading on psychosocial stress and CVD. Wow, mind blowing!

Katherine Moss: What's CVD?

Barbara Martinez: Cardiovascular disease

Katherine Moss: Ahhh thanks.

Name withheld and writing rephrased: Can you elaborate on what you are studying? It seems obvious that stress causes disease is there anything else?

Chris Aloia: a direct causative pathway has not been established etiologically, at least in humans. Most of the research points to stress as a modifier. Meaning that high stress causes poor lifestyle choices, which lead to poor health outcomes. Only a few researchers consider stress a direct cause. So there is a big debate that has been going on for at least 10 years and it has my full attention.

Dana Janezic: The evidence is there for a direct cause in baboons though so it really won't surprise me when they find it for humans.

Chris Aloia: yeah, Sapolsky again! But you can't randomize humans to stress. I think one group in Germany did it once, it is called torture. But there have been some awesome studies by extremely clever researchers. I buy it as a direct causal agent. The implications are intense!

Katherine Moss: Kind of gives new meaning to the phrase "broken hearted"

Dana Janezic: I'm of the school that thinks that when it comes to testing humans, we will be creative enough to come up with tests that don't involve torture. I really don't understand people who just give up and relegate human sciences to soft sciences... when we live in a world where people were creative enough to figure out how to test for the existence of neutrinos.

You're absolutely right, the implications are paramount. Think about the 30 year fixed rate mortgage in these terms. 30 years is a long long time for bad things to happen to a person all the while they have the stress of the obligation on that monthly note. It's particularly interesting when you consider the fact that the 30yfrm is a political creation...

Aaron Irons: Stress can indeed be a direct cause of cvd, whether left brained methods of perception, research or experimentation come to a widely held consensus or not. I mean that respectfully, while recognizing inherent biases in perception and thus accepted routes of validation which can become so familiar and accepted that the mental structures used to do analytical analysis can become their own barriers to equally valid insights and experience as well. With this respected such methods certainly have their use and place. As long as we remember to also release over attachment to them and allow for equal validity of so called right brain feeling, experiential, creative and perceptual capacities.
Even the short term effects of perceived stress with its effects of blood pressure, heart rate, adrenaline, fight or flight response can noticeably effect cardiovascular system unhealthfully to point of triggering angina, heart attacks and possibly strokes. Body sometimes overcompensates in its responses to perceived stressors by releasing, inhibiting or creating insulating fats, hormones or other chemicals which can have their own damaging effects.

Chris Aloia: Aaron, you bring up a great point. There is consensus that acute stress can induce a heart attack. However, short term stress does affect the cardiovascular system but to extrapolate that to CVD mortality is where things get VERY hazy.

And you are also right that individual perceptions of stress play major role, which again confounds the stress as direct causal agent theory because what triggers one person's stress response may not another.

Everyone is searching for hormones that are more stable markers for early stage CVD. Even Sapolsky has baboon blood in storage for the sole purpose of a discovery of a new hormones. Incredible! Thanks to all for posting. it helps me put this whole field into perspective.

Katherine Moss: Here's an idea for a study that doesn't involve torture. Put out a call for volunteers to participate in a study who describe themselves as "under severe stress". They would fill out a form describing their stressors: such as death in the family, job loss, divorce, child with medical issues, etc. Maybe they could be interviewed as well. Interview questions could include what level of social support people have, how often they see family and friends, if they feel comfortable discussing problems, if they belong to a church or other clubs, etc...Then they donate blood and it is examined. They have full cardiovascular workup. It could be a longitudinal study where they follow same subjects over time and ask about their stress levels and then compare results of heart tests? I realise that self selection isn't the best way to gather participants, BUT you would be getting people who subjectively see themselves as "stressed" which, as you say, varies from person to person even though they may be going through the same situations one person's stress might be greater than another. Just some thoughts. I'm sure someone is already doing this type of thing?

Chris Aloia: Yeah this has been done many times. The key is there is NO stable measure of stress. Self-reported stress can be confounded by lifestyle choices because people who report higher levels of stress are usually of low-income. low-education, they smoke more, etc etc. So no one knows which causes what. Does stress cause poor lifestyle choices? Do poor lifestyle choices create higher levels of stress? Is it education? Is it childhood SES? Crazy interwoven complexity and I love it.

Katherine Moss: What if the researchers eliminated those of low income or education or those who smoke from the pool?

Katherine Moss: I'm sure there are plenty of rich, well educated smokers who are stressed. In fact, they could use college professors as a start! LOL

Chris Aloia: Besides all these very interesting ideas above, there is also a political side. There is a mountain of evidence that shows a good chunk of the explanation for poor health outcomes are from social structures. The implication here is that what many call "human agency" is not as strong as some Republicans might argue. The pulling one up from the boot straps happens a lot a lot a lot less in low-income areas and even middle-income as well. This means the elites not only get the cash, the babes, the vacations, but they also live longer. Got to love that! Human civilization is more animal than human in my mind. I have no trouble with Darwin.

Katerine Moss: sad but true.

Sustainable Health Promotion

On February 2nd, Denise Stevens, the head of Matrix Public Health Solutions, the company that leads the Community Interventions for Health (CIH) project, was beamed into our classroom via Skype to present the CIH project strategy for chronic disease prevention. She laid out an extremely ambitious health promotion strategy that spanned 3 risk factors: tobacco, unhealthy diet, and physical activity; 3 countries: Mexico, India, and China; and 4 approaches: health education, social marketing, community mobilization, and structural change (Stevens, 2011).

The CIH intervention I think is the most emblematic of what it takes for sustainable health promotion is their tobacco reduction campaign in China, which has “smoking center inspectors” enforcing a city wide no-smoking ordinance. This one got my attention because not just anybody can waltz into China, a country that the WHO reports is “the world's largest producer and consumer of tobacco,” and establish an anti-smoking police force to enforce a CIH strategy. I had been studying sustainable health promotion for almost a decade, from WHO’s EPI to BRAC and including my own struggles with small-scale community health promotion. It seems I have never been able to grasp that elusive ingredient for sustainable health promotion. So here was someone drinking from the Holy Grail; I shot my hand up to ask, “how did you make that happen and who pays for it?”

It turned out that she knows the retired head of the Chinese version of the CDC and that the Pepsico foundation is a major funder behind CIH’s projects. She pointed out the prestige that comes from working with American partners is a bigger incentive for many of her international partners than money.

This funding and prestige revelation led me to research the Pepsico Foundation. Its goals and mission are in step with Pepsico’s own corporate mission and are found on the corporate website. CEO Indra Nooyi supports taking the lead in corporate responsibility and cultivating sustainability in the environment and health arenas (2010b). With Pepsico specifically in mind, I drew a concept map to illustrate the interaction between a corporation attempting to create a sustainable health promotion program in a globalized world and the communities it serves. With Pepsico’s war chest and corporate efficiency, they can fund community projects all over the world and gain access to academic and political elites “to help devise solutions to key global challenges” (Pepsico, 2010b). My map also shows the cycle of profits that fuel Pepsico, as their mission cannot be totally altruistic.

The hard truth is that health systems all over the world struggle to deliver primary care or health promotion, especially to the least fortunate (Frownfelter and Dean, 2006; Holman and Lorig, 2004). One of the main reasons for this is that the demand for secondary and tertiary care is less affected by price (Roberts et al, 2004). This means that when people are sick they are willing to pay whatever it costs to save their own life. This high demand creates a stable need for professionals and thus status becomes attached.

“Basic food” is another high demand commodity (Roberts et al., 2004 p. 164). There will always be a demand for food, and companies that control the food market are some of the richest and most powerful. Ironically, many of their products are partly responsible for exacerbating the prevalence of some chronic diseases.

In contrast, health promotion, and even primary care are extremely price sensitive and do not generate the high revenues like acute care services (Roberts et al., 2004). Simply put, people in general don’t value something that may prevent possible future costs and are less willing to create a demand for those services. This is why I believe that corporations are better poised to deliver health promotion. The new trend in corporate responsibility and sustainability provides the funding, visibility, and sustainability for health promotion in ways that other entities cannot support. Thus, it is important that we in public health can see this as an opportunity to develop public-private partnerships to ensure that such corporate campaigns deliver the right information.


References

Frownfelter, D., Dean, E. (2006). Cardiovascular and pulmonary physical therapy evidence and practice. St. Louis, Missouri: Mosby Inc.

Holman, H., Lorig, K. (2004). Patient self-management: a key to effectiveness and efficiency in care of chronic disease. Public Health Reports, 119:239-243.

Pepisco. (2010a). Corporate fact sheet. Retreived on . Retrieved on February 6, 2011 from www.pepsico.com/Download/PepsiCoCorporateFactSheet.pdf

Pepisco. (2010b). Letter from Indra Nooyi. Retrieved on February 6, 2011 from http://www.pepsico.com/Purpose/Performance-with-Purpose/Letter-from-Indra-Nooyi.html

Roberts, M. J., Hsiao, W., Berman, P., Reich, M.R. (2004). Getting Health Reform Right: A Guide to Improving Perfomance and Equity. New York, Oxford University Press.

Stevens, D. (2011). A systems oriented solution to a complex public health problem. [PowerPoint slides] Retrieved on February 19, 2011 from Simon Fraser University webct http://webct.sfu.ca/webct/cobaltMainFrame.dowebct?appforward=/webct/viewMyWebCT.dowebct

WHO. Towards a tobacco-free China. Retrieved on February 16, 2011 from http://www.wpro.who.int/china/sites/tfi/

The History of Tai Chi and Health-Part V: Tai Chi in Western Culture

This is the last article in the history of Tai Chi and Health series

The current view of Tai Chi in Western popular culture is that it is primarily a Chinese exercise for elderly people, and not one particularly ideal for cardiorespiratory fitness. Some people who are interested in martial arts see Tai Chi as a viable form of martial arts training. The definition used commonly by both Western and Eastern researchers is that “Tai Chi is a low impact, low to moderate intensity exercise incorporating elements of balance, strength, flexibility, relaxation, and body alignment” (Taylor-Piliae and Froelicher, 2004, p.49).

A broader view, however, is presented in a 2002 demographic survey done in the United States, which found that more than 2.5 million people practiced Tai Chi and 500,000 practiced Qigong (Birdee et al., 2009). The age range was evenly split throughout all age groups, countering the stereotype that Tai Chi is primarily for older adults. Birdee et al. posit that because Tai Chi has roots in martial arts, it increasingly may be viewed as masculine and attractive to younger people (2009). The majority of the Tai Chi and Qigong users was Caucasian, but proportionately there was no difference in race or ethnicity; most had a healthy BMI and self-reported good health. The authors also found that 11.4% of the users practiced Tai Chi for a cardiovascular workout. From this study, it would appear that a large number of people perceive Tai Chi as a cardiovascular workout and good for health maintenance.



It is really important to stay open and re-invent yourself and re-invent Tai Chi. Many people, especially physical activity researchers want to place activities into categories. As a researcher myself, I understand the rationale for this. There has to be some kind of standardization so other researchers can test hypotheses. The problem is then the practice becomes limited. As a Tai Chi practitioner and someone who wants their life to be a work of art, I seek to be unlimited. Tai Chi is fresh and new NOT only an ancient exercise for elderly people.

The History of Tai Chi and Health-Part IV: Tai Chi and Chronic Disease

In 1973 in Hunan Province, an archaeologist unearthed a silk scroll dating back to c. 168 B.C., which depicted exercise postures. Below each embroidered pictograph was a written “exercise prescription” for different types of diseases, many of which were chronic conditions (Cohen, 1997). This evidence suggests that long before this recent surge in research, early Taoists had devised a method of self-care in the form of exercise to manage chronic conditions. Today, a growing body of evidence suggests that Tai Chi may be an efficacious intervention for the primary, secondary and tertiary prevention of CVD, diabetes, and the determinants of those diseases (Kaptchuk, 2000; Taylor-Piliae and Froelicher, 2004; Thornton, 2008; Yeh et al., 2008). However, of all the studies conducted on a broad variety of diseases, the literature on Tai Chi for the primary prevention of CVD is one of the least explored.

The History of Tai Chi and Health-Part III: Tai Chi’s Use for Health Promotion

When Mao Zedong took power of China in 1949, he outlawed all traditional practices, including TCM, Tai Chi, and Qigong, and viewed them as superstitious (Chen, 2004). However, during health reforms Mao and his advisors began to see Traditional Chinese Medicine, including Tai Chi and Qigong, as an opportunity to aid in primary healthcare (Xu, 2010). Mao saw individual physical fitness as a sign of a strong nation. Qigong and Tai Chi fit into his vision of active masses, and his efforts in primary care inspired much of the Alma Ata conference in 1978 (Janes, 1999; Xu, 2010). Because Mao was a modernist who believed in science, a tremendous research effort began to explore Tai Chi and Qigong. Thus, Tai Chi and Qigong had to prove not to be merely a mystical superstition through using tools of scientific observation, which at that time were mainly large case studies (Kaptchuk, 2000; Xu, 2010).

Today in North America, Tai Chi has a variable and intense research history. It has been used and studied as an intervention on AIDS patients, haemophiliacs and just about every type of disease imaginable. One search on Google Scholar using the search term “Tai Chi” yielded 24,700 hits, and a search of the Cochrane Library website brought up reviews on Tai Chi and hypertension, headaches, depression, rheumatoid arthritis, fall reduction, and dementia.

One of the first influential studies on Tai Chi in the US was in 1996, when a team of researchers received funding from the National Institutes of Health to study Tai Chi and fall reduction (Wolf et al., 1996). There have been many studies replicating its efficacy in fall reduction, and it is included in many recommended guidelines for that purpose, including those issued by the Canadian Society of Exercise Physiology (CSEP, 2008), the US Department of Health and Human Services (US DHHS, 2008) and the American Physical Therapy Association (APTA, 1999).

Not many studies have been conducted on exploring its potential use in primary prevention, meaning preventing disease before people get a disease. I think this lack of research has to do with many preconceived notions people have linking Tai Chi with elderly people or because it is slow. Also, there is some controversy in exercise science fields as to how much of a role VO2max plays in prevention of cardiovascular disease. Recently, there has been some research that suggests musculo-skeletal strength plays a larger role than previously thought. If that is the case Tai Chi can maybe a good exercise for the primary prevention of cardiovascular disease.

Next The History of Tai Chi and Health-Part IV: Tai Chi and Chronic Disease

The History of Tai Chi and Health-Part II: The origin of Tai Chi

The origins of Tai Chi are rooted in mythical Chinese culture. The Chinese credit the celebrated hero Zhang San Feng with the creation of Tai Chi. Legend has it that he observed a hawk attacking a snake. As the battle between the two animals ensued, the snake repeatedly used relaxed evasive movements to elude the aggressive attacks of the hawk. Finally, the exhausted and frustrated hawk flew away. There are several versions, using different birds, but this is the basic myth (Frank, 2003). However, the true origins of Tai Chi are in dispute. The first historical record shows Tai Chi was developed in the 17th century in Chen Village (Yang, 2010). Later, Tai Chi was passed on to Yang Lu Chan, who developed the Yang style, which is now the most popular and most researched.

Yang Lu Chan’s grandson Yang Cheng Fu became the inheritor of the Yang tradition. He defined Tai Chi as “the art of concealing hardness within softness, like a needle in cotton” and asserted that “its technique, physiology, and mechanics all involve considerable philosophic principles” (Wile, 1983, p.3). He popularized Tai Chi for the masses and distinguished two levels, the civil and the martial (Wile, 1983). The civil is the “essence” and can be used for development of health, which is referred to as a type of gong, or practice or skill. In this way it falls under the umbrella of Qigong, a type of Qi-based exercise that literally means the practice (gong) of moving life’s vital energy (Qi) (Cohen, 1997). The martial is the “function,” which has the civil in mind but can be used for self-defense (Wile, 1983). Traditionally, Tai Chi is often taught in this martial manner, in which learning the form is not an end unto itself but a first step in which the basics are internalized. Then, after a year or so, the student learns push hands and sword practice. Thus, Tai Chi is a martial art that contains within it self-healing principles intertwined in martial movements.

As Tai Chi has developed through the centuries and through various schools of practice, it has become not one specific set of movements but can be practiced in different forms. Empty hand forms are usually the main focus of most Tai Chi classes. “Long forms” contain many more movements than “short forms,” which are not traditional but are modified to ease the learning curve. Different traditional styles are descended from the Chen but have evolved as various families transformed them, including the Yang, Wu, Sun, and Li styles. The variability of forms and intensities of physical activity among them is one of the challenges in understanding Tai Chi.

This infusion of healing movements with martial movements signifies Tai Chi as a unique exercise. Many people compare it to Yoga but it is quite different because of this martial aspect. I know of many people who study Tai Chi solely for martial practices but predominantly Tai Chi is a healing exercise. This is especially the case in the US, where so many combative styles are promoted. Tai Chi has a comparative advantage in that it offers a mindfulness Qi-based exercise.

The next post will explore Tai Chi’s involvement in Health Promotion

The History of Tai Chi and Health-Part I: Tai Chi and Traditional Chinese Medicine

This series of blog posts will be in 5 parts. Hopefully providing a broad and in-depth picture of Tai Chi. For the first installment of The History of Tai Chi, we must explore its connection to traditional Chinese medicine or TCM.

Tai Chi is part of traditional Chinese medicine (TCM), both of which are indigenous practices from China. Because these holistic approaches are rooted in a time when doctors did not have today’s powerful medical and technological tools at their disposal, physicians tended to treat the whole person and the environment around them (Cohen, 1997; Kaptchuk, 2000). TCM, born thousands of years ago, epitomizes this approach (Hong, 2004; Kaptchuk, 2000). Health systems of that era were radically different from today, with no medical technology to speak of; secondary and tertiary prevention was not as efficient or effective. Consequently, people who lived prior to the advent of modern medicine had to be resourceful and devise systems of primary prevention, which were essential for survival.

At the basis of the TCM system stands Qi, which is often translated as a fundamental form of vital energy that animates all living things (Yang, 2009). Some scholars explain Qi’s place in Chinese thought as “a formless ‘reality,’ which, though not graspable by the senses, is immanent in all things” (Xu, 2010, p. 967). This belief in Qi is also essential to Tai Chi, which shares many principles with TCM and has been integrated into the TCM system.

Both Tai Chi and TCM are rooted in the Chinese philosophy called Taoism, which is based on intense observations of patterns in nature, such as the movement of water, wind, and rocks. Early Taoists developed treatises on longevity, hygiene, and immortality, and these ideas fuel much of Chinese culture. Feng Shui, dietetics, martial arts, painting, and TCM all use the same paradigm or explanatory model of how the universe works (Kaptchuk, 2000; Kohn, 1993; March, 1968). The individual is but a microcosm of the universe, and to achieve harmony or happiness, one should align himself or herself with Qi to stay in harmony with the melding of energy and matter (Kaptchuk, 2000). If an individual becomes un-aligned or a blockage occurs, then disharmony can fester and “dis-ease” or disease will result (Yang, 2009).

Taoism is represented graphically by the icon known in the west as the “yin-yang” symbol, which illustrates a balanced interrelationship of opposites—for example, night and day, and hot and cold, etc. (Frank, 2003; Kaptchuk, 2000). Embedded in its Taoist roots, Tai Chi literally means “grand ultimate point,” (Yang, 2008) the point of balance in the yin-yang. The oldest known writing that discusses yin-yang theory is the “I Ching,” or “The Book of Changes,” which describes the natural ebb and flow of energy in the universe and how that effects change, written during the Bronze Age, 1100 B.C. (Hong, 2004) (Yang, 2010). Tai Chi’s main aim, to harmonize or align oneself with Qi, was summed up by the Taoist sage Chuang Tzu in the 4th century B.C.: “Set your body straight, see everything as one, and natural harmony will be with you“ (Lan, 2002, p.217).

Next post will explore the beginnings of Tai Chi.

Alton Brown and the Science Behind Salt

For a few years in late 1990’s, I worked in a kitchen gadget store in Seattle. We made many product recommendations to our customers, and of all the celebrity chefs we touted, Alton Brown received the highest ratings. Unfortunately, he chose to use his celebrity status and reputation against the public health campaign for salt reduction.

Alton Brown is a successful author, television show chef, and TV show presenter who writes and produces many cooking shows on the Food Network. Brown’s main show, “Good Eats,” presents him as a culinary expert, and his television work has made him a very influential person in the food industry. That is why I was shocked and disappointed to see Brown adding his unique touch of comedy and science to the promotion of salt, sponsored by Cargill, a multinational corporation that produces salt and other food products. Cargill and many others in the processed food industry have been battling public health and its salt reduction campaigns since the 1970’s

Cargill’s latest crusade to promote salt includes an interactive website dedicated to Brown’s pitch: http://www.salt101.com/#/intro. The website features Brown as a tour guide/lecturer at Salt 101 Labs. In an extremely formal environment that screams power, he spouts about 10 facts about salt, such as “salt is goood!” “salt is a necessary component to the natural functioning of cells,” “sodium chloride, NaCl, is a compound all humans need to survive,” and “whoever controls salt is in power, and in my home it is me; I control the salt.” The message is clear, salt is not only tasty, but it is also good for you, life sustaining, and powerful. There are also interactive games where, for example, you can move Brown’s arm to season a meal with salt.

After viewing the intro, the user can click to enter the “lab” or the “kitchen.” Both links present authoritative information about salt with a bias towards using more. Brown is in his element explaining technical details to viewers. He excels at explaining the science of food, such as human taste, the chemical make-up of salt, and why it is so effective at enhancing flavor. The scientific facts sound reasonable and non-controversial, and it is unlikely there are factual errors in the science Brown presents. The real problem with the videos is not inaccuracies in scientific reporting but what information is omitted. In fact, there is only one potentially negative comment about salt: putting salt on snails will kill them because they are mostly made of water.

The one potentially redeemable aspect of the video is that they do recommend sea salt—Diamond Crystal sea salt to be precise—because sea salt has less sodium than regular salt. But this is still without much value because of the excessive promotion of adding salt to food.

While it is true that salt is necessary for sustaining life, the missing pieces of information are that humans only need a tiny amount (1,200 to 1,500 milligrams per day) and that excess salt consumption (above 2,300 mg per day) is strongly associated with serious health risks like hypertension, cardiovascular disease (CVD), and stomach cancer Cardiovascular disease is the number-one killer globally, and hypertension is one of the strongest predictors of CVD mortality. Brown’s salt industry presentation does damage to the health initiatives trying to reduce mortality.

There is no doubt that we as humans have cultivated a salt craving. Much of the world’s population consumes salt in quantities of greater than 6,000 milligrams per day, with Eastern European and Asian countries averaging higher than 12,000 milligrams per day. In 2004, the average Canadian daily salt consumption was 7,800 milligrams. Observational studies going back to the 60’s, conducted on indigenous peoples where salt consumption is low have shown that hypertension, the leading cause of CVD mortality, is extremely low there as well, making them a low-risk population. These groups of people had salt intake levels hovering around 1,000 milligrams per day.

Companies like Cargill make their money by “adding value” to food, which means they process it for the consumer. Processed foods account for 70% of the salt in the Canadian diet. For example, the label on a pack of Oreo cookies states that one serving (three cookies) has 160mg of sodium, which is 1/14th of the maximum recommended amount. To further encourage people to put additional salt on chocolate covered cookies and ice cream—a recipe proposed by Brown in the video--is nothing short of dangerous to public health.

Such companies have an incentive to promote salt content in foods, and consumers have built a taste for it. The taste for salt can be reduced, but it can be difficult to change, so any doubt cast on the evidence or authoritative messages proclaiming that salt sustains life make it that much harder for public health practitioners to protect consumers.

The exact pathogenesis of salt is not known, and that leads to the doubt exploited by industry. That is why an etiological understanding of salt’s effect in humans is an important step in regulating the processed food industry. Thus far, the most accepted explanation is that excess sodium in the human system can lead to decreased sodium excretion and water retention. This increases plasma volume and increases vascular tone and contractility, which increases blood pressure, resulting in hypertension.

The Salt 101 video portrays salt as healthful, nourishing, and empowering. By combining Brown’s comedic genius with the persuasive potential of social media, Cargill seduces viewers to ignore those charged with protecting the public health.

(References available upon request)

Vive L’amateur

In the mid 90’s I started taking an Aikido class in Seattle’s Chinatown. The crisp throws and graceful falls were all I needed to become hooked. The school advertised itself as “Aikido taught by professionals,” and was affiliated with a larger school north of the city. The instructor at the Chinatown dojo was a clean-cut young man, and as typical in martial arts school from Japan, he had a stern, militant voice.

I started the class because I needed to break a life pattern. The artist’s undisciplined lifestyle had been taking its toll, and I had had enough. Martial arts had saved me when I was a kid, and I knew it would do it again. As I began going to classes, first three days per week, then five, I became addicted, as did the other 20- and 30-somethings in the class. The class had a bunch of young men and women who bonded around Aikido’s unique philosophy of non-violence and non-aggression.

The students got along really well, and we thought we’d found the perfect school for us. Then, after about a year, these “professionals” started to make some changes to both the curriculum and, more significantly for me, to the payment plan. It was a time in the martial arts world when signing yearly contracts became popular, and the head instructors decided that was a good business model. In addition to requiring a contractual commitment with a lump sum up front, there were also tests fees, new uniforms, and other added expenses. It became a hefty sum of money, one that my wife and I could not comfortably afford.

When I balked at the new expenses, asking if there was a way to avoid some of them, the instructor railed into me, saying I wasn’t serious about Aikido and questioning my priorities. His response made my next move easy. I never returned. I soon found another martial art and dreamed of opening my own school. But after much reflection, I realized that to be a “professional” means making money and capitalizing on the role as a respected teacher to persuade students to purchase contracts, uniforms, and anything else that can bring in a profit. This is not illegal in any way, but it doesn’t sit right with me for one reason: trust. At the end of the day, a professional’s job is to make sure he or she is in the black. So they have to devise ways to excite, inspire, and persuade students to invest in the school’s future and purchase things, things they might not actually need.

Since then, I have decided not to open a school for profit or to formally attend one. Instead, I occasionally visit teachers whose primary income is not from their martial arts classes. That squarely makes them “amateurs,” which gives me a sense of trust and passion—after all, amateur means “lover of.” The amateur passes on knowledge because it provides meaning to their lives and, they believe, to the lives of others. Long live the amateur!

Summary of the Canadian Health Care System

Canada is ranked as the second largest country in size but 39th in population (CIA, 2009). These two factors combine to make it quite unique. The Canadian health system is just as unique. Bordering the United States, which has the antithesis of a single payer health system, Canada has maintained one of the most successful health systems in the world for the past 40 years.

With more than 80% of the population living in urban areas, the health system can make primary and acute care accessible to a large population (CIA, 2008)(WHO, 1996). Life expectancy is among the highest in the world for both men and women at 79.6 (StatCan, 2001). The infant mortality rate (IMR) for 2005 was 5.4 per 1000 births, making it one of the lowest in the world (StatCan, 2005). Since life expectancy is so high and IMR is so low, 12% of the population is over the age of 65, a high percentage of older population. Added to the fact that fewer people are having children, this means that Canada is in the fourth stage of a demographic transition.

The Canadian health system has some of the best health outcomes in the world, with death and disease rates lower than most. Still, only 52% of Canadians say they are satisfied (Gallup, 2003). One of the major complaints is long wait times for special services such as MRIs and other high demand treatments.

In 1957, the Hospital Insurance and Diagnostic Services Act (HIDS Act) was passed, establishing single payer insurance that implemented universal coverage for inpatient hospital care. The HIDS Act set into motion a foundation on which the Canadian health system as we know it was built. It evolved into the national health system, which provides universal coverage to 10 geographically and culturally diverse provinces (WHO, 1996).

Funding and Spending

Many people call the Canadian system “socialized medicine” but actually it more closely resembles a Medicare system where the heath insurance is government sponsored. This means that physicians are not hired by the state but are privately employed and are paid fee-for-service by the government using taxpayer dollars (Davis, 1999). In 2006, Canada spent $3,672 per capita, and health costs were 10.0% of Gross Domestic Product (GDP). Seventy percent of total health costs are publically funded (WHO, 2006); thirty percent comes either from private insurance, employer insurance, or out-of-pocket (Davis, 1999).

Structure

The Canadian health care system has two main levels of power. The first is the provincial, in which the health ministries take on the day-to-day management of health services. The ministers of health plan, finance, and evaluate all types of care, e.g. hospital, physician, and public health. Provincial health ministries must also fund all public health activities and negotiate fees (WHO, 1996).

The second level of power is at the federal level. The federal government's role is to set and administer national standards for the health care system. Another federal responsibility is providing health care delivery to veterans, native Canadians living on reserves, military personnel, federal prisoners, and the police. The final function is disease surveillance, prevention, and health promotion (WHO, 1996).

Primary Health Care and Public Health

The lion’s share of primary health care is delivered by a general practitioner or a family doctor. Since they are the first point of contact in the health system they filter access to specialists, admission to hospitals, and other health professionals (WHO, 1996).

The original intent of public health was to control and prevent communicable disease. Since communicable diseases have mostly been ameliorated in Canada, public health has extended its mission to include health promotion and equitable distribution of health services to all members of society, as well as prevention of non-communicable disease and support for mental health services (WHO, 1996).

The Role of the Private Sector

Besides a single payer health system, there also exists a private sector. Canadians might opt to go to the private sector because of dissatisfaction with the public system or to seek an alternative and complementary treatment. The government is not responsible for payment of claims for those who elect to choose that option. There are many doctors, chiropractors, dentists, and such who operate outside of the government provided system. In addition, there are private insurance companies that can supply employers with supplementary health insurance (WHO,1996).

Conclusion

One admirable aspect of the Canadian health system is that it doesn’t rest on its laurels. Building on its foundation of universal coverage, Canada strove even further to insure all of its people. Using the public health system to focus on health promotion and health equity, Canada has achieved some of the best health outcomes in the world. Today’s topsy-turvy economy raises many concerns regarding sustainability. Even in that arena, Canada has created many ways of cost containment, thus promising a continued healthy future for its healthcare system.

References

CIA , World FactBook. (2009). Canada: people.
Retrieved from
https://www.cia.gov/library/publications/the-world-factbook/geos/ca.html

Davis, J B.. (2001). Canada’s health system. Croatian Medical Journal 40(2).
Retrieved from
www.cmj.hr/1999/40/2/400221a.pdf

Gallup. (2009). Healthcare System Ratings: U.S., Great Britain, Canada.
Retrieved from
http://www.gallup.com/poll/8056/healthcare-system-ratings-us-great-britain-canada.aspx

Statistics Canada. (2001). Life expenctancy.
Retrieved from
http://cansim2.statcan.gc.ca/cgi-win/cnsmcgi.pgm

Statistics Canada. (2005). Infant mortality.
Retrieved from
http://cansim2.statcan.gc.ca/cgi-win/cnsmcgi.pgm

World Health Organization (1996). Health Care Systems in Transition: Canada.
Retrieved from
www.euro.who.int/document/e72450.pdf

World Health Organization (2006). Canada: statistics.
Retrieved from
http://www.who.int/countries/can/en/

The True Power in Tai Chi

Recently one of my martial arts friends asked me to work out, and I had to decline because of the broken scaphoid bone in my wrist—an old injury—and two other recent injuries. My knee most probably has a tear in a tendon from walking on the broken sidewalks in India with 100 lbs of luggage this summer, and my shoulder tendon has been burning every time I reach for something. Alas, the sounds of a wimp! But, hey, that is the true state of my body.

My friend’s response, “Very problematic, there are more than a few pro (motorcycle) racers who had to retire just because they broke that bone [the scaphoid]. It wouldn't heal and that was it. Such a small bone, but it can be such a bitch!”

After reading that email I immediately felt the loneliness of retirement and even more so, the loss of identity. I have been managing pain by rationing my martial arts workouts literally for 20 some-odd years. My wrist can only take so much activity. But maybe it is time to face facts. I am a type A personality and not the typical kind of person you find at a meditation class. I love sparring and getting hit and all that, but being type A means that I push it too far too often. Even my wife has been getting on me for instilling the martial ethic into my young son.

All my life I have been type A. When I was picked on in high school by the football team, I didn’t just rollover and take it like everyone else. I started to box, I ran 8 miles a day, punched the heavy bag for hours per day, and I did push-ups and sit-ups. My workouts lasted for hours. My work reaped the success I sought, and by the time I was a junior, I was no longer being picked on. Then when high school was over and I had to get serious about something society valued, I chose to be an artist. Of course in typical type A fashion I again went over the top with drugs, alcohol, and all that comes with that lifestyle. These activities led me to have some minor health issues.

This was the original push to get me to seek out Tai chi, because it is recommended for type A personalities. Many of my injuries and heath issues were linked to this type A drive. I changed many of my habits, like my expression of anger, slamming my fist on a desk, which took a toll on my body. But in time I gravitated back to the more martial aspects of Tai Chi and found a way to keep the martial artist in me alive. In Tai Chi Chin Na I found Jiu Jitsu correlates, and in Tai Chi sword I saw similar characteristics with Kali stick fighting. Again I was using Tai Chi as martial training, not solely as a health exercise, further exacerbating my wrist injuries.

Maybe because of this persistent injury, I am starting to see Tai Chi from a different perspective, as injuries always have a habit of inspiring. I used to think that a Tai Chi master could heal broken bones and beat a 25-year-old professional fighter. When I first started Tai Chi I believed that by simply practicing Qi gong and Tai Chi I could heal my body to a superhuman level. I thought by developing Qi, I would be able to throw a football player 10 feet and that I would never get sick. In my 12 years of serious Tai Chi practice I see that it is not the cultivation of a superhuman ability but some thing far more simplistic. It is the opposite of type A—it is about yielding control and letting things come to fruition on their own. Accomplishing that is harder than breaking coconuts and throwing heavier opponents to the ground.

A famous Tai Chi master came up with a phrase that explains that the essence of Tai Chi; “invest in loss.” This simple concept has been a struggle for me since I began my practice. As a westerner in an eastern practice, I have a hard time reconciling the two approaches. The westerner in me asks, “how did the US become a superpower but by being type A?” Getting to shape the world in a major way is no small accomplishment. Eastern wisdom tells us this is short-term, it will pass. I wholeheartedly agree, but it is comfortable being on top even if it is for a relatively short period of time, like 500 to 1,000 years. Eastern wisdom is beautiful, and it is one of the best ways for all of us to coexist in a world that needs a way of curbing excessive human consumption. If we regulated our desires, many of the issues surrounding global warming could be attenuated.

Giving up martial arts is really hard. It is addictive for me because in martial arts you gain victory by defending against would-be attackers—and to give up creates a certain cognitive dissonance. The whole point of your martial life is to defend yourself. Not being able to do that is to deny everything that you worked so hard to acquire all your life. But just as a champion’s life is so short because there is always going to be someone younger and stronger willing to knock you down for the glory, one must eventually yield.

At this stage in the game for me, Tai Chi is not a miracle cure or a superhuman growth supplement but a form of exercise that can keep me active, which is a miracle in itself. It is also a means of managing pain and that translates directly into living an active life. As it is now with my wrist I could easily stop working out as working out brings pain. Tai chi allows me not to quit and to avoid that slippery slope of inactivity but instead to persevere.

The true power of Tai Chi is a far cry from the hype of internal martial arts promoters for one simple reason: there is no mysterious, esoteric secret. It is the practice of overcoming the part of you that looks for short-term victories and instant gratification. It helps you understand the bigger picture, but with that comes responsibilities and sacrifices. It comes by letting go of your desire to win.

Is there an inverse relationship between tradition and regulation? A Comparison between Canada and India

Indian culture is one of the oldest if not the oldest living culture still going strong. Without a doubt, one of the factors that generated that kind of longevity is tradition. Regardless of how we might judge tradition with a 21st century lens, a strict family structure with rigid social and cultural norms has got to be one of the reasons for India’s perseverance.

One of the hardest to understand cultural differences between India and Canada is the tradition of marriage. “Dr. Sanjay” (not his real name) is in his 30’s and a typical upper-caste Indian man. He is very handsome and tall but yet single. He is a senior resident doctor of community medicine at PGI. He led a tour of the community health center in Kheri for a group of doctors from North Koreans and myself. The North Koreans doctors, Dr. Sanjay, and I discussed each of our country’s courtship rituals on our way back to PGI medical center. The North Koreans asked if he was married. He said, “no.” As we were discussing this, a beautiful young rural woman passed by our van. I said, “in Canada, if we found her attractive we could approach her and ask her for a date, and if things worked out it is possible to get married. “ Dr. Sanjay said, “That would be next to impossible here.”

Another part of our tour was to observe a public health class. During the class discussion about private and public health, I was invited by the teacher to speak about the Canadian healthcare system. Being an American who lived without health insurance for many years and who now resides in Canada I had a pretty good personal perspective on each system. After sharing my experiences about the Canadian system, the students discussed the Indian health care system. I was impressed by their description of India’s far-reaching delivery of health to its people, but this interaction prompted me to ask an important question: why does Canada have generally very good health outcomes but India has some really poor outcomes?

I began to try to think of reasons and issues besides the obvious ones like population and colonization. This led me to a peculiar realization. India has one of the most rigid social structures on earth, yet the ability for the people to follow government regulations seems like a monumental task. And paradoxically Canada has very little real tradition, and there is no rigid social system. You can walk out of your house and marry anyone you please, and yet if you drive without a seatbelt or on the wrong side of the road you would be severely punished maybe even lose your license. To me the striking difference is a culture of safety—seemingly simple safety regulations that most people in Canada have no difficulty following are almost non-existent in India.

This difference makes me wonder if the health system is the most important way of preventing mortality. This question led me to develop four ideas that, in theory, could take the burden of prevention out of the hands of the health system. These include 1) a general culture of health awareness, 2) stronger regulations, 3) definite and immediate accountability for infractions, and 4) improved infrastructure like clean water, safer roads, sidewalks, etc.

While these are challenging and sometimes expensive endeavors, I have noticed an improvement in some of these areas since my last trip to India, in 2001, in things like public smoking restrictions and at least minimal seat-beat laws. Changing culture is rarely easy, but it won’t happen without starting somewhere. Public safety has to be assimilated into construction, food production, the work place, transportation and any business where people can be harmed by products.

Canada has great infrastructure. Water for human use is filtered and treated to a high degree of purity, roads are safe, and building construction is highly regulated for safety. Contractors and developers can get arrested if they cut corners on building codes, there are elected officials in charge of checking on zoning and building codes of safety, and they have the authority to stop construction or penalize a contractor if unsafe construction practices are used. These regulations are designed for both the construction phase, to protect workers and the public, and for the completed phase, to ensure that buildings don’t collapse or require nearly immediate repairs.

In addition, driving in India is a high-risk activity. On the 5-hour drive from Chandigarh to the Delhi airport, I saw two immediate wrecks probably involving fatalities, three trucks overturned, and numerous automobiles driving on the wrong side of the road. To a North American observer, this disregard of road safety seems to be a point of pride with many Indians, as if they see any demonstration of fear about daily driving habits to be a sign of weakness. This type of cultural myopia is hard to change. When I discussed road safety with many people, they often laughed at our concern and shrugged off the seriousness of accidents. But road accidents in India are extremely high.

According to a Boston Globe article using World Health Organization statistics, “road accidents now are the number two killer of young people age 5 to 29 worldwide…. [In India], an estimated 270 people die each day from road accidents, and specialists predict that will increase by roughly 5 percent a year.”

Many cars do not have operable seat belts, and children ride on motorcycles and scooters without any protection. In Canada this practice is illegal. In fact, it is also so culturally abhorrent that people would call the police and look down on such a person. Because I am a cultural relativist, I don’t judge Indian people who chose to ride a motorcycle with a child, as I understand there are many factors that influence behaviors. But I am concerned about safety. My biggest fear in India is seeing an accident involving a child being slammed onto the asphalt—if I witnessed such an incident I would never forget it.

Much of India’s charm is its stalwart retention of its culture, even in the face of westernization. In Canada, without the long tradition and strong culture, sometimes there is a loss of identity, as people seem to be grasping for something to believe in. Also, such stringent regulations can sometimes be claustrophobic and create a backlash. It is precisely in this dilemma where the public health worker inside me, who believes in safety and longevity as a human right, and the dedicated traveler, who believes that culture is what makes us unique, collide. But I do think a happy medium can be achieved slowly.

Personal Paradigm Shift

Spending 11 weeks this summer in India, where the heat is 109 degrees and walking 4 days per week, administering surveys door-to-door, negatively affects my daily routine of Tai Chi. It is simply too hot to move. I have been doing some Chi Gung at night before bed. But I still feel like I am missing my daily one-hour routine of Tai Chi. I have felt jealous of my friends back in the US who aren’t missing a beat in their own practice. Then I had an epiphany that led to my own personal paradigm shift.

My choice of going into health research as opposed to acupuncture or some other health care delivery was just the beginning of incorporating my research into my life. Scientific research is a systematic method of adding knowledge about the world around us by collecting data, lots of data. My research here in India is trying to ascertain how people’s dietary habits impact their physiology. What I am finding thus far is that small, simple choices in an individual’s and a culture’s diet can negatively impact their life span. In short, people’s cultures are killing them slowly.

My research in India takes me door-to-door asking people in their homes about their lifestyle choices. Everyday I meet people who are overweight, with high blood pressure, not exercising, making poor dietary choices and of the age where their first MI (myocardial infarction, or heart attack) is not far off. So many of them think that they are healthy and that they are eating just fine. They truly are in a state of denial. The stats tell another story: About 17.5 million people die from cardiovascular related deaths every year. That is 30% of all deaths in the world, which means that CVD kills more people than any other disease.

Although I haven’t been doing as much Tai Chi as I like, I am seeing first hand through a scientific lens that, overwhelmingly, lifespan is determined by the choices people make day in, day out, many of them based on cultural norms. The average life span in India is 64 years of age. The people I meet here are creating a pattern of behavior that will affect their child’s life span as well. Science has given me the tools to see this. By collecting data from hundreds of people I can infer whether a certain behavior is rampant or not. If you just follow a tradition or culture that is orally interpreted or passed down in books you might not notice what is actually happening on the ground. A state of denial is created because tradition is kind of like a rule book or a map following it confirms you are doing well. Unfortunately, many of the directions are flat out wrong or not appropriate to the present time frame. I am finding that the people of India follow their traditions and are very devout, much like people of other places, but unfortunately without that scientific lens they can’t see where the health outcome of their tradition leads. The Hindu religion states the eating of meat is forbidden, with beef strictly taboo. Although the attitude toward chicken is more casual, many people proudly don’t consume it for religious reasons. However, chicken is a more efficient protein, with less fat, than the daily consumption of whole milk (in tea and drunk plain), paneer (a type of cheese), and whole milk yogurt that makes up a big part of the Indian diet.

Even in my beloved Tai Chi there is very little information on dietary behaviors. There is some wisdom on the balancing of the 5 elements and their dietary correlates: sweet, sour, salty, pungent, and bitter. Unfortunately, it doesn’t give any measurements or of course the wise sages could not fore see the transition from a rural old world diet rich in whole grains to a modern diet full of processed refined grains heavy in salt and sugar. Consequently, Tai Chi instructors without training in western science do not pass on that kind of wisdom. The Tai Chi literature also says to avoid any type of cardio activity. Although there is some wisdom within those words when applied to elderly people but it is poor advice for middle-aged adults who are in need a cardiovascular exercise for their heart.

Absorb what is useful, discard the rest

It is difficult not to be influenced by cultural traditions. Tradition gives many of us meaning in life and even makes us aware of many positive activities as well. The Tai Chi literature is full of all kinds of awesome behaviors to follow, that is why I love it and read so much of it but there is a fundamental lack of precision. Following the scientific method gives me the insight of what is actually happening on the ground from the data collected. The choices I make of which many come from the Tai Chi literature are tempered and corrected by the large body of literature amassed by the western science paradigm. So I can as Bruce Lee has advised, “absorb what is useful, and discard the rest.”

IS there such a force as CHI, QI, or PRANA?

At the very end of the day, this is what we know: physical activity is one of the best activities for preventing a whole array of diseases. Greeks, Indians and Chinese knew this but did NOT or could not empirically prove it. They all created an energetic system of healing. Greeks had Pneuma, Indians have Prana and the Chinese, Chi. But we also know it is it is really hard to exercise everyday, maybe those ancient teachers knew this too?

Until someone actually does a study like one I have designed which isolates Chi practice from physical activity then there can be NO proof of any single activity that people claim cultivate Chi is valid. In other words, all the positive effects of 'Chi' could easily be explained by physical activity. My study would not prove the existence of Chi itself but it could prove that activities which claim to cultivate Chi are more efficacious than running on a trend mill. Maybe one day I will find myself in a situation where I could run that experiment. Or maybe a new technology will come along that measures Chi?

One of the biggest issues in discussing, explaining or even harder, proving Chi is that we have to fuse together two explanatory models about the world. An explanatory model is a structured thought or diagram or paradigm, which attempts to make sense of our world in a simplified way. Hence the only way to explain Chi must be in terms of physics and biophysics. The Chinese had no knowledge of what we would call modern physics but they did understand how to make use of it. This is where we run into problems, I could say Chi is energy but there is a whole field called thermodynamics that also deals with energy. I could say, Chi is the movement of neurotransmitters in the body; again there is a whole field of science that researches this. Unfortunately by applying an old language to a new science much gets lost in translation. Then why use Chi at all? Part of me thinks it is not necessary and part of me thinks that the concept of Chi gives us something to grab onto when explaining complex bodily functions. While leading a lesson on Tai Chi I can’t say, "now let’s feel the release of dopamine and serotonin." It is so much more convenient and accessible to say, "let the Chi sink into your belly." But I also feel it serves another purpose.

The activity of learning and exploring through being thoughtful or mindful is also extremely beneficial towards living a long and healthy life. Many cognitive psychologists are finding that if humans learn something new and complex they are less likely to suffer severe memory loss. Being thoughtful about Chi and its interactions with the complexities of our physiology serves two purposes. One, it keeps my mind active reading higher level material instead of playing video games, which have not proved to prolong memory and two, it motivates me to return to practice, day in and day out. The outcome of which is a highly functional system of cognitive and physiological benefits both inspiring each other. If the mystery of Chi keeps me practicing for 50, 60 or more years than that is quite an achievement by itself.

The paradox of physical exercise is that our minds know it is good for us but the mind has to motivate the body to get up and do it consistently for there to be any benefit. What if the mystery of Chi Gong is so complex that is can not be empirically 'figured out' as so many of us try? That makes it the ultimate cliffhanger created by a most wise sifu. If you ever have a chance to meet one of these people after-death or otherwise, and you finally get to ask that one burning question that has been tugging at you for years, "is Chi real?" Sifu would say, "the mind is dumb and the body is the smart." "Ah ha," you say, "I knew it was a trick all along." And before that smugness has a chance to settle, the sifu responds, "But the mind always has to be right."

Tai Chi below Shannon Falls in BC

The practice of the Tai Chi form reaches its apex for me when performed in nature. The first step in learning the Tai Chi is the basics. Once the body mechanics are understood, the applications of each posture need to be comprehended. This develops an ability that demonstrates good structure. Structure is how the body handles pressure. Bad structure collapses under pressure and good structure does not. Once these elements are understood on a general level the most satisfying part of Tai Chi is not being able to defeat multiple attackers, but simply moving and interacting with nature. When you feel you are able to follow nature and understand it as if you were the rider and it was a horse, you are in a place to realize a deeper part of yourself and to improve upon the many weaknesses you endure while living in this complicated world.

Please do not take these words as some type of fixed idea that you complete one step, the basics, then another and so on to the final stage of development, rather take them as a process. By looking at your learning as a work in process, you can shed the idea that there is some kind of fixed state, and you might be easier on yourself.

Sometimes we work the basics and move on to realization, and back to applications, then realize that you totally forgot the basics and have to start all over. The process of Tai Chi can be frustrating but it is important to be easy on yourself and remember to love what you are doing and then do it often.

My letter to Barack Obama about Health care in America

I am a 44 year old American in graduate school in Canada. I am seriously considering applying for citizenship there. The major justification for this decision would overwhelmingly be free health care.

Since I have been there I have not had to battle ANY health care request, whereas my experience in the United States has been quite the opposite. I have had wrist pain for the past 20 years. I have been to multiple doctors in the US. None of them ever addressed the issue without first suggesting pain killers as the solution. While the idea of relying on painkillers is good for the pharmaceutical industry, it is repugnant to me. I then retreated to alternative health care as so many Americans do. Alternative treatments brought me some success but the pain continued. Finally, in Canada, a doctor had a novel idea, a CT scan. I was finally correctly diagnosed, after 20 years with a broken scaphoid bone in my wrist.

I know that a small broken bone doesn't sound like a traumatic disease that has ravaged my life, but I have made major changes to my life because of it. I have been physically active all my life and there are many enjoyable activities and some jobs that I can no longer perform. It is also significant in that it is so small but yet for America so large and expensive.

I have an appointment this September with an orthopedic surgeon in Canada. I feel confident that if he thought he could repair my wrist with a costly surgery, there would be no obstacles in my way. Unlike his American counterpart who would gladly offer the surgery, but then I would have to figure out how to pay for it. In the US, I had to drop health insurance because the $500 per month was too high and my policy probably didn't cover it anyway, because it would have been a ‘preexisting condition.’

The irony of all this is that the injury happened while I was working my way through college in my 20's. I find it ironic because while contributing to the economy I was injured. I was too young to realize the implications of my injury. As an older man the pain from my wrist has a place at the table when decisions are made. I have to listen to it before I engage in certain activities and even certain jobs. Amazingly, even conservatives in Canada realize the importance of single payer health care. The irony continues because here I am at the peak of my ability to contribute to the economy but my country will not assist in my health, and a country not of my birth will gladly do what it is right. As I get older health increasingly becomes a top priority, so how can I resist an excellent opportunity that will insure my health into my golden years?

Why I Chose a Career in Public Health....

When I re-entered University at age 39, my purpose was to get a better job in the health-care field. My top choices were physical therapist, psychological counselor, or acupuncturist. During my first semester I began to see that physical therapy was much like a car mechanic and that the daily work would be fixing people's knees and other parts that were broken and, most importantly, that PTs don't have as much autonomy as I'd like. The doctor diagnoses the injury and prescribes the regime. I was much more interested in the mind's role in healing and prevention. In psychological counseling the therapist works with patients on a number of behavioral issues, not just physical health. I began to research health psychology. Around the same time, I found some studies on acupuncture that questioned its ability to heal any disease, and there was no real emphasis on prevention. After many years of studying Taoist healing practices that focus more on prevention than acute repair, I wanted to help prevent disease from beginning in the first place.

Near the same time, a friend passed on a book entitled The Status Syndrome by Michael Marmott. In it the author explained that diseases manifest themselves in a population differently with regards to social class. People at the top of the social hierarchy live longer than people at the bottom, including the radical discovery that people with PhDs generally live longer than people with a Master's degree and right on down the line. The issues raised in that book caused me to have a spiritual crisis and led me to pursue a career that relies less on religious faith and more on personal empowerment and education. It also sparked a strong desire for discovering an empirical basis to substantiate claims about efficacious healing practices.

In addition, I grew increasingly frustrated about our western health system, which is based on a model designed to combat acute trauma and infectious diseases. Unfortunately, that model is ineffective in preventing non-communicable diseases (NCDs) because they are about lifestyle choices made by the individual, heavily influenced by cultural norms and pressures.

The western medical system approach is top-down, meaning that doctors tell patients what to do. Because of medical advances over things like bacteria—which have been great in reducing infectious diseases and the burden of those on hospitals and communities—doctors and the medical establishment have been given too much power over areas where they are not particularly effective. This kind of power has a tendency to narrow people's vision, so that the current model is excessively preoccupied with physiology and the view that everything is biologically determined. So the focus is on high-ticket items like surgery rather than cost-effective, preventative, lifestyle changes.

For non-communicable diseases such as cardiovascular disease and diabetes, the need is greater than ever to create a system that can raise awareness and motivate people to change high-risk behaviors. This approach aims to keep people out of the hospital for things like heart surgery by keeping them healthy in the first place.

This is why I look to other, decentralized health systems as a model for dealing with education and prevention issues. Systems like those at various times in Bangladesh, Cuba, Pakistan, the state of Kerala in India, China, and the parts of the Philippines have designated roles for ordinary people to become community health educators. These people function as disseminators of information to rural regions where doctors are unable to access. These decentralized systems accomplish two amazing things. First, the distribution of medical knowledge creates a less hierarchical system in which more people can share in the decision making process. Second, and most important, these community educators more easily reach marginalized groups, which often have a heavy burden on healthcare systems. Using education programs between people who are on the same status level is an effective tool alongside a top-down authoritarian approach.

When it comes to many diseases—particularly non-communicable ones—awareness is an essential ingredient in preventing a disease from becoming a major player mortality rates. And so much of maintaining good health is about having access to information. For example, we are seeing a reduction of cigarette smoking in developed countries because more people in those places have become educated about the overwhelming evidence about the dangers of cigarette smoking. In less developed countries, there has been an increase in smoking because those places have not been able to enact effective campaigns about the ills of cigarette smoking. But in due time, we will see a reduction in cigarette smoking in those places, too, as health education systems have time to catch up. As with cigarette smoking, condom usage, diet, exercise, clean water and clean hands, many other preventative behaviors can also be taught and learned.

All these issues combined to lead me to a degree program in public health, with an emphasis on non-communicable diseases. For me, public health can be the “ounce of prevention [that] is worth a pound of cure.”

What’s the Buzz about Mindfulness?

In America, mindfulness has been a buzz word since the 80’s and it is just as strong now as it was when it first appeared on the scene. Usually, a buzz word’s life span is pretty short. There is no doubt that mindfulness has staying power. Even though mindfulness has only been in the USA for a few decades, it has fascinated cultures around the world for thousands of years. Currently, there are a group of scientists who are trying to understand what exactly it is about mindfulness that makes people feel so good. The purpose of this essay is define and draw a distinction between mindfulness and meditation. 

Mindfulness is a good term because it implies that people can control their bodily drives by applying their mind in a particular way. It shares many qualities with self-regulation, and all people need that kind of reassurance. In fact, many human pursuits attempt to impose some type of regulatory principle over the body’s “evil” defaults of carelessness and selfishness. In Eastern mindfulness practices, there is a place for the mind to share in the internal regulation of bodily functions not just simply behavior modification. Unfortunately, many people confuse the terms mindfulness and meditation. They are often used synonymously but there are major differences. Mindfulness has been defined many ways. The most common definition is by Jon Kabat-Zinn, who defines mindfulness “as paying attention in a particular way on purpose, in the present moment, non-judgmentally.” Ellen Langer and Herbert Benson were some of the first people to explore this phenomenon. In her 1974 bestselling book “Mindfulness,” she gives us many related phrases like “being open to process.” Later in her 2000 paper on the construct of mindfulness, Langer states her definition this way: “The concept of mindfulness can be best understood as the process of drawing novel distinctions.” Herbert Benson went a different route. He looked at the physiological measures of meditation and found that meditation lowers the heart rate. He called this process the “relaxation response” (Benson & Wallace, 1972). Langer’s and Kabat-Zinn’s definitions make similar points. Langer’s “process of drawing novel distinctions” and Zinn’s “paying attention to things we ordinarily never give a moment’s notice to” propose that the mechanism of action within mindfulness is a cognitive one, while Benson relies more on physiological correlations. 

As you can see, there is still a lot of confusion surrounding the definition of mindfulness. It is a relatively new concept to the West and there are many components to mindfulness. In fact, mindfulness is such a broad term that it maybe impossible to truly define. One important point to bring up is that there are two meanings to mindfulness. First and foremost, it refers to a state of being in which one is being very careful and focusing attention on the task at hand while still keeping the mind open to new possibilities (my definition). Secondly, when many people use the term they actually mean meditation. Meditation is defined as a technique for self-induced manipulation of awareness. When the definition says, “technique,” it is referring to any activity such as, walking, sitting, moving, doing the dishes, and even lying down; really any action that requires intense focus with the intended purpose of altering consciousness.  So when athletes mention “being in the zone” they are talking about a special moment when then are deeply focused and all actions seem effortless and coordinated. My definition of meditation is a category of techniques that build self regulatory awareness over the mind and body, while maintaining a mind open to new possibilities.   

While teaching Tai Chi for the past 7 years, I became interested in how Tai Chi could develop a type of control over the body’s movements. One could control the distribution of weight from one part of their body to another. This more subtle level of control is a skill and it takes time to develop which is rather useful when one has an injury. If the front of one’s knee has a strain, that person could redistribute the weight towards the muscles in back of their knee and avoid re-injuring the front. The interesting element here is that people can intentionally regulate which part of the body received the majority of force or weight. Based on my experience and research in mindfulness meditation, it appears to me that meditation is the same technique of dispersion that is done with the body, only applied to the mind. It has been demonstrated in psychology that people often focus on a small portion of reality when speaking about it in the past tense. That theory is called, focalism. If mindfulness allows a person the ability to shift the attention to other aspects and broaden or enrich the person’s perception of reality in the present moment, then it is a similar tool as Tai Chi. 

I believe that shifting attention happens because of the sensory systems of the brain. Humans have five sensory systems, an optical, auditory, olfactory, gustatory and finally, somatosensory or touch. It is here in the very order that these senses are listed in every scientific text published, is also where our problem begins. Our culture is so visually and auditorily oriented that we suppress or ignore the other senses. When we have a problem we deal with it in our limited ways. This happens so many times we develop a repetitive motion injury of the mind. Our thinking becomes fixated on a narrow set of information and then we have trouble seeing beyond our problem or obstacle. We remain inside a small box. Mindfulness allows an opportunity for the other senses to contribute to our perception of the moment. We feel things emotionally and physically, we also hear things from outside this narrow margin of reality that our cognitive resources confine us to. Mindfulness opens up that door to other possibilities. It brings us outside that proverbial box. Also, we have to mention other possible senses that are not yet recognized scientifically. Although, this might make some scientists wince it is important to understand that things like, x-rays and wireless were science fiction, not too long ago. So that wince could slow the advancement of science. We must remain open to the possibility of other senses if we are to discover them. 

Finally, we could sum up that mindfulness is a large umbrella term that entails many components—for example, some type of “special awareness,” an internal sensory awareness with an external cognitive lens that allows out-of-the-box thinking. There is also a relaxation component and some physiological skills as well, such as posture and breathing; these components of mindfulness work together to assist in regulating these powerful biological determinants. Meditations have a different focus, referring to a specific means, where as mindfulness is a general state of being; a tactics vs. strategy kind of thing, meditation being the tactic and mindfulness being the overall strategy. With meditation, one could be more cognitive in nature while another is more physical. There are many components of a meditation practice, such as breathing, posture, relaxation, and usually a lecture giving instructions on how to deal with thoughts, especially emotionally-charged ones but they are focused. In mindfulness anything could be done mindfully from throwing out the garbage to painting a wall to sitting in a temple in front of a statue of the Buddha. The meditation would be called throwing out the garbage meditation, or painting wall meditation if of course they were performed mindfully. So here we are, meditation is the vehicle with the aim of achieving a state of being called mindfulness. 

A New Art

When I graduated high school in 1983, there was this sudden pressure to do something. One either had to get a job or go to school or something. I got a job at a grocery and thought for a while about what would be the best position in society for me.

Being 18, I wanted the "job" with the most freedom. My parents had a friend who was a struggling artist and he had this really open-minded perspective on life. So I chose to become an artist. My parents were not too happy with this decision but they knew I wasn’t going to change my mind that easily.

I started drawing everything I could. I eventually went to a college for art. I was as passionate about art as anyone had ever seen. I specialized in painting and sculpting. I had even carved totem poles for a motel in Taos, NM.

As I explored art, I was continually amazed at the artist’s calling for pushing limits of what art is. One of my artist role models is Joseph Beuys, a German performance artist who really broke new ground. He was an artist in the academy before WWII doing representational themes in paintings, drawings and sculptures. Then he was called to serve in Hitler’s army as an fighter pilot. He was shot down a few times. The last brought him closest to death. He was shot down and was found by a tribe of people who saved his life by putting him into a felt cocoon surrounded by fat. When the war was over he knew standard academy painting would never be able to externalize his past experiences. He began doing elaborate performances, which set his career off and changed the art world.

After 12 solid years in the art world, I had a profound experience during a martial arts class. We were asked to make 100 Japanese sword cuts with a wooden Katana called a Bokken. I can’t remember what number I was on but I got myself into a state. Then all of a sudden a black passageway opened up and I felt hyper-aware. That experience of an altered reality changed my perception of the world. Art itself seemed pale and utterly cheap from that moment on. I tried to paint that experience for the next few years with some feelings reminiscent of that first experience but it wasn’t until I started doing T’ai Chi and Qi Gong that I was able to get back to that place.

Once this new method of altering my consciousness began my art production slowed to a trickle. I found that Qi Gong and T’ai Chi could replace and surpass any internal feelings that my art was able to do.

My next step was to share that feeling with others. After becoming relatively proficient in some Tai Chi and Qi Gong forms, I felt comfortable enough to teach other people. But I seemed to keep bumping into some obstacles. Many people in society viewed these forms as either, stale and static or just for old people.

So my next challenge was how to change the way society viewed these activities. I went back to school and completed my bachelor's degree in psychology. Studying social psychology it becomes abundantly clear that people have many preconceived notions that are informed not from direct sensory experience but from socio-cultural norms they learn. Many people in society relegate art to a painting or a sculpture that is executed by “artists.”

T’ai Chi and Qi Gong are really not considered as anything more than an exercise for older adults who are in need of assistance. Even martial artists have been patronized by being Asian-philes who break boards and shout like cavemen. Our society has these narrow perceptions of what all these things are. Our whole society is compartmentalized so much that you would think nature is as well. Compartmentalization is a major flaw in our highly industrialized society. The problem is those of us in the West have to name everything, which seems harmless but limits the object once it is named.

Even fellow artists often ask if I still paint or make art. There is no possibility in their minds that the act of performing Tai Chi is the creation of art. Art to me has now become that amazing feeling when my body seems to open up and glide on the earth's crust weightless and painless and ready!

Holidays and Qi Gong

Holidays are an awesome time in American culture. I love Thanksgiving. It is a time when everyone loosens their belt and indulges more than normal. It was a great morale boosting necessity during periods like the Great depression and when our ancestors were building this country. Unfortunately our current lifestyle is too indulge everyday. So during the holidays we increase that base level of indulgence. The way your brain works is when it gets used to something it develops new neurons to accommodate that new level of being. This is called plasticity. It is a great adaptive tool which allowed humans to do so well on this planet, however there is a down side to plasticity as well, once you have lots of sugar and great tasty treats your body has already adapted to a new sensation so it will now crave them.

One really smart coping method is to be pro-active about this process. Accept the fact you are going to indulge yourself but make a commitment to doing a short Qi Gong routine every night. Put on a DVD and follow along. I am a teacher and I do it all the time. In fact, I will be doing just that at 6:00 am this morning. Forget about silly ideals that are unrealistic which then work to undermine your positive efforts to begin practice. If you start a self practice in addition to coming to class, you begin to reinforce that practice into a daily routine. When January comes along you will not be one of those people who join a gym as a band-aid for your guilt, then by February have already stopped. The gym workers just sit back and laugh when January comes along. All the new clients are so enthusiastic and the workers know that most new clients will stop by February.

An Ounce of Prevention......
I know everyone has heard that saying but now is the time to put that in to action. Start a little now and later it will be easier. In January when everyone is trying so hard to retrain their tastebuds and get themselves back into shape, I will be making a small effort to bring myself back to baseline. This is also the same as controlling your balance point. In the Tai Chi classics it is written, "Smaller movement is better than big movements." This is true because it is easier to control smaller movements it takes less effort.