[Note that this blog is a work in progress, and that this and following posts are not final and set in stone. I may revise them later as I find out new facts or just think more deeply about the topic.]

Health – in our current life it has become almost a national obsession. Daily we are deluged with media reports about health, how to achieve or maintain it, what the latest research says about X, what to eat or not eat…. And yet there are more questions left unasked, let alone answered. Why, for example, do more people die of heart disease now than tuberculosis (which killed my aunt in 1920)? Why do people in northern climates get multiple sclerosis at a rate many times that of people in the tropics? Why is pellagra, once a scourge of the American South and parts of Europe – virtually unknown there today? Why is death by gun so much more common in the US? Why are people so panicked by Ebola virus in the Congo when other diseases such as measles and pneumonia kill many more people there? Our fates as individuals are bound up in the fate of the groups we belong to, and when and where we live. Just what does that mean in practical terms?

Perhaps we can turn some of these questions around, and ask them in reversed form, a form that gets overlooked in the clamor of why this or that pathology waxes or wanes. And so we can ask one of those “invisible” questions – what do people in a particular area need as a group to be healthy?

Let’s explore a few of these elements, which we’ll investigate in further detail in the next few posts on this blog.

The first obvious element that we need is air. We have to breathe, on average 15 times a minute. And that air needs to be reasonably pure, so that it doesn’t poison us along with giving us the oxygen we need. Air pollution is such a major topic that it will be handled in a separate post, a bit down the line, so on to the next element.

The second element, and one that we take for granted (unless we live in Flint, Michigan) is clean water. You just turn on the faucet and drinkable water comes out. But what if that isn’t the case? What if all the water you have to drink is polluted with microbes or chemicals or just plain dirt? Well, first of all, you’ll almost certainly get sick just from drinking the stuff. The number of diseases carried by contaminated water is staggering – legendary killers like cholera and typhoid down to the “runs” that plague tourists drinking water filled with unfamiliar bugs. And if the water is impure, how do you wash with it, or keep your dishes or your clothes clean? Hand washing with soap and water is one of the most effective disease prevention strategies known (as you no doubt heard last flu season). But what if the water itself is contaminated? And what if just wading in your local rice paddy or irrigation ditch can give you schistosomiasis or liver flukes?

And not only is clean water crucial for health, it’s also becoming more and more a scarce resource. The major use of water isn’t drinking – it’s agriculture, irrigating thirsty crops for food and profit. Industry uses another major share (and usually pollutes what it uses in the process). Competition for usable water is becoming a growing source of tension all over the world – even in the US, where the clash between California’s cities and agriculture over water from the Colorado River basis is becoming a major issue.

We can only survive a few days without water, but beyond that crucial need, the next most obvious is food. In contrast to clean water, which we take for granted, what we eat is a subject of endless fascination for Americans. What, how much, when, how to eat are endlessly discussed in the media and socially. For most of the world (and actually us, under the hype), there are four basic questions. Is the food enough? Does it have the necessary components? Is it safe? Can I be sure that I’ll have enough today, tomorrow, and in the future?

How much is enough? Speaking in simple terms of calories, the average adult needs around 2000 a day. People can survive on much less, but their immune systems don’t function well, and they are in danger of coming down with diseases that better-nourished people would fight off easily, and of course they have much less energy for work, school or any other task. The necessary components we all recognize as protein, carbohydrate, fats, and the various vitamins and minerals. A deficiency of any of these leads to specific diseases, especially the vitamins like vitamin C (scurvy) and pellagra (vitamin B3). Before the discovery of vitamins in the early 20th century, some of these seemed mysterious indeed. For instance, pellagra was thought to be a contagious disease.

Food safety is something that we are becoming more aware of. It almost seems that every month there’s a different recall for some food that’s been contaminated with E. Coli or Salmonella. But there are other dangers lurking in the refrigerator, for instance, poisoning by some metals. In the 1950’s people in Minamata, Japan, began developing strange and terrible neurological problems – paralysis, dementia and birth defects. Eventually the cause was traced to a chemical factory located on the same ocean bay as Minamata. Mercury from the plant was discharged in wastewater into the bay, where it was taken up by fish and shellfish that formed a major part of Minamatans’ diet. And you may have noticed advisories cautioning pregnant women about not eating too much fish, because it’s contaminated with mercury.

So we have three major elements here – the needs for breathable air, enough clean water, and enough of the right kind of food, all of which have been protected from various kinds of threats. But there are other things that determine how healthy we are, and our next post will take up a few of them.

When I began this blog in 2015, my major interest was still cross-cultural psychology. Time passes and people change. Since then, I have pretty much given up on psychology, especially social psychology, and have returned to a previous interest in public health.  I will be leaving my original posts up, but from now on the blog will reflect that renewed interest. The first series of posts will answer the question you haven’t asked yet, but should: What is public health as opposed to individual health, and why should you care? Essentially, it will be a short primer on health as a matter of communities, not just individuals, and how it matters to you.

The first post of the new sequence should be up in a week or so. See you then.

Taking a bus, driving a car – exploring the texture of doing things.

The impact of change is usually painted with broad strokes – the Industrial Revolution, the Internet Age, the iPhone age – and yet the real impact of change and new technology is felt directly in people’s everyday routines and interactions. Take the car, for instance. It’s usually described in terms of urban sprawl, air pollution and changes in teen dating practices. But what does it mean in terms of the daily patterns of our lives? And we must remember that easy transportation of any sort is a fairly new factor in our lives.

Up until 1850 or so in most countries transportation for most people was by foot, and limited to a few tens of miles a day, or by horse or stagecoach for the well-off. Only with the moving of most people to the city did horse-trams appear, offering longer-distance transport for the public within cities. Then came the electric streetcar, railroad train and commuter services, later subways and motorized buses. But these all were public – in all sense of the word. The well-to-do had their enclosed carriages, and later their luxury cars, but for most people going anywhere beyond the immediate neighborhood involved a foray into the public domain of life. Then came Henry Ford and his Model T, and private transportation for the “masses” became a reality. (I still have a snapshot of my grandfather standing proudly next to his Model T.)

Now getting places became independent upon what the rest of the city or town was doing. As cars became more advanced, they also became completely enclosed – a private space within the great outdoors, yet mobile. Think how this has changed our experience of everyday life. There are changes in its basic rhythm and its place within the web of our interactions with other people – the basic textures of our lives.

Stop and examine the process of something as simple and routine as a bus trip in the city, and observe all the details that are involved. Follow it in your mind, imagining each step in order.

First, I have to check the weather. Will it be cold? Will I need an umbrella? (If the weather is very bad, I might even have to postpone the trip.) Then, the bus routes have to be considered. Does a bus even go there? Will I have to change lines? What about the schedule – weekend or weekday, and is it frequent or only episodic? And do I have change for the bus? Except for the metro train stations, bus drivers can’t give change, and there are no provisions for credit or debit cards, so I have to have the money in coins or dollar bills. All this even before I can start out.

I go out on the street, and immediately things become unpredictable. On the way to the bus stop I may meet someone – friend or stranger – and they may greet me or start a conversation. In Baltimore, strangers passing on the street say something like, “Hi?” or “How you doing?” just as a friendly acknowledgement of another human being. Or it may be a neighbor, and I have to greet them, then decide how long I can chat before missing my bus. When I get to the bus stop there may be someone else waiting, and I may or may not have a conversation with them. Since it very seldom happens that the bus comes immediately, I have to wait a bit. The passage of time becomes noticeable – I am not in control of when the bus comes.

The bus comes and I get on. First, I speak to the driver, show my ID for my senior pass and put in my money. Then, it’s time to find a seat. I look up and down the aisle, noting not just which seats are empty but who is sitting where. I am now in a public space, as in fact I have been ever since leaving the house. Who is in that public space and what they do is mostly beyond my control. Some people may smile at me, some scowl, some will ignore me. They may be old or young, men or women, my race or ethnic group or not, well-dressed or scruffy. But they will all be different, different from each other and different from me. If there is a row empty, I can sit there, but otherwise I have to choose who to sit next to. That person may ignore me, or have to move a bag to give me space, may smile and even start a conversation (which I may or may not want). Whether I will it or not, I have to interact with other people.
Time is again important. I have to know when to get off, so I have to watch where the bus has come, and pull the request cord in time. As in waiting for the bus, I have no control over how long the ride takes – it takes as long as it does, and I have to pass the time some way. I can read, stare out the window, watch the other people (sometimes watching me), snooze, think about something, or just blank out. When I get off I may have to ask someone to move to let me out, and I will of course wish the driver a nice day.

But consider what happens when I drive (hypothetically, since I don’t own a car). Except in extreme circumstances (blizzards, hurricane warnings), weather is irrelevant. Timing is also unimportant, unless it’s rush hour and I need to allow extra time. Of course I need to know my route, make sure there is enough gas in the car, take my license, etc., but this is almost trivial.

Then I get into the car, and again, I’m back in my own private space. The car is a little bit of my own territory, probably cluttered with objects useful and discarded, and with a lock on the door to keep outsiders out and my stuff in. I don’t move directly in the world, but encased in my private castle. On the road, I don’t encounter other people as people, but by proxy, through their cars. Very seldom will I speak with or directly look at another person. I am in a mobile, semi-private space, moving through the restricted area of streets. Of course I must keep an eye on other drivers and adjust my actions to theirs, but it is always at one remove. Cars have a limited behavior repertoire – speed up, slow down, veer right or left. There are few surprises, except for other drivers doing dangerous things.

Two different actions – two different textures. One is full of actions, occurrences in the environment, meetings with other people. The other is cocooned, stereotyped, and basically solitary. The texture of one is varied and unpredictable, engaging attention, thoughts and emotions. The other is stereotyped, limited and bland. What difference does this make to the mind of the person experiencing them?

Our world since industrialization and urbanization has tended more and more to the bland, untextured type of experience, much different from human lives in the thousands of years we lived before. In future posts I will look at several other types of experience from this perspective – work, buying goods, conducting friendships.