Author: MattMasielloMD

  • War No Longer an Option for Our Nation

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    “In the counsels of Government, we must guard against the acquisition of unwarranted influence, whether sought or unsought, by the Military Industrial Complex. The potential for the disastrous rise of misplaced power exists, and will persist. We must never let the weight of this combination endanger our liberties or democratic processes.”
    – Dwight D. Eisenhower, 1961.

    “It’s a growth industry and we will get what we want.
    – Gen. David Petraeus, when asked recently about the need for the deployment of more troops to Afghanistan.

    As we came to the end of our walking-wheelchair trek from the Jefferson Memorial, Korean and Vietnam War memorials, to the World War II site, my 82-year-old mother offered a most surprising comment.

    “We Americans sure like our wars,” she said sadly.
    This from the wife of a WW II veteran who was awarded the Silver Star and a Purple Heart for his heroism.

    It was that simple comment that made me pause and reflect on where we were as a society, a country.

    I am also the sibling of a two-tour Vietnam War veteran who suffered through the aftermath of that conflict. Drugs, joblessness and life without a wife and children were his rewards.
    Thousands of our young have died, depriving us of a social force that may have brought us to a more peaceful, a more academically enlightened, and possibly a more environmentally friendly time decades later.

    Dwight Eisenhower said it best when he commented on the need for war to “prevent” communism, terrorism or world domination: “When people speak to you about a preventive war, you tell them to go and fight it. After my experience, I have come to hate war.”
    As thousands of our young soldiers have died in our current wars, many more thousands have returned with a multitude of war-related illnesses.

    And as we were underprepared to properly equip and protect our soldiers on the battlefield, so are we now so ill-prepared to care for these young Americans, their children and their wives upon the soldiers’ return to our communities.

    And again, another generation lost and a country missing out on what could have been – would have been – if these thousands of young men and women were here today, healthy and alive.
    The compromised physical and mental health of these soldiers will have an immeasurable toll on their families, our health-care system and our country for years to come.

    “The time not to become a father is 18 years before a war,” E.B. White said.
    A conservative number of 100,000 innocent Iraqi and Afghan men, women and children have died in these wars.

    An apology and a few thousand dollars are offered as payment for loss of home and life.
    For generations, the families of these innocent victims will hold us accountable for their sadness, misery and loss – a breeding ground for sustainable acts of terrorism.

    “And one of the things we should learn is you can’t fight and win a civil war with outside troops, and particularly not when the political structure in a country is dissolved. So it wasn’t the press that was the problem. The problem was that we were in the wrong place with the wrong tactics.”
    – Robert S. McNamara, secretary of defense during the Vietnam War.

    One in eight Americans and one in four children now rely on food stamps. We have more families and children living in poverty now than we did during the Lyndon Johnson war on poverty era.
    In this nation, a child is born into poverty every 33 seconds (Children’s Defense Fund, CDF).

    As we continue to experience the numbing greed of Wall Street, we have more children going to bed hungry than ever before.

    According to economist Jeffrey Sachs, “Wall Street takes more bonuses each year than the U.S. gives in all official development assistance.”

    Many of our community food pantries were finding it difficult to keep shelves stocked for this past Thanksgiving, and quite possibly will for the upcoming holidays and holy days.

    According to Marian Wright Edelman, president of CDF, we spend $60 billion per month on the war. It will take $105 billion over 10 years to provide maximum health-care reform for children. What is the child worth? Who are we?

    As our health system is fragmented and failing, our educational system is also suffering.
    The high school dropout rate is unacceptable by anyone’s standards.

    Our science and math scores are noncompetitive at the international level, and the ability of our students to obtain degrees once they enter college is surprisingly and sadly low.

    Our children still do not have the right to an education and health care as is the case in other modern, industrialized countries.

    Our young adults leave their educational environment thousands of dollars in debt before they have their first job offer.

    This is not the case in the great majority of other modern societies.

    We still abuse children by the hundreds of thousands, with one in 10 suffering some form of maltreatment. More than 10,000 children are known to have died from abuse and neglect from 2001 through 2007. The number could be much larger.

    Nations are staging special events to mark the 20th anniversary of the Convention on the Rights of the Child, which came to be on Nov. 20, 1989. It is the most widely ratified international human rights treaty. Every country in the world, with the exception of the United States and Somalia, has ratified it.
    Poverty breeds social unrest and violence. Though we need to be intelligently and morally responsive, militarily, to terrorism, the real war to win is that on poverty.

    Our military experts are now negotiating with the Taliban, realizing that they fight for food and money, regardless of who pays.

    According to Sachs, it will take one-tenth of one percent of the world’s gross national product to provide basic financial support to the world’s poor. And $35 billion, total, as compared to the $60 billion per month on the war effort, to significantly and positively alter the course of world poverty.
    When Gen. David Petraeus, the overall commander of U.S military forces in Iraq and Afghanistan, was asked recently about the need for more troops, his response was, “It’s a growth industry and we will get what we want.”

    Many Americans are now approaching that Vietnam mind-set of war weariness, and at a time when we are in a deep economic depression.

    There is discussion of a war surtax just as we are realizing the cost of overhauling of our health-care system, upgrading our educational system, and moving to cleaner, more-efficient energy sources.
    It is also the poverty, the hunger and the declining spirit of the masses.

    “The most successful war seldom pays for its losses,” Thomas Jefferson said.
    I believe this country has a “machine” as strong and powerful as our military machine of generals and war strategists.

    “Give peace a chance” should no longer be a cliché of the past. Today we are much better prepared to call upon and muster nations, economists, community planners, sociologists, educators, medical and public health professionals, and political peacemakers who can strategically infiltrate a society in conflict, or a country experiencing massive poverty, and reap significant gains with significantly less loss to life.

    It is time for a new world order – whether it be with the advice of a well-known Demo-crat, John Kennedy, “Mankind must put an end to war, or war will put an end to mankind,” or that advice of another distinguished soldier, Gen. Douglas MacArthur, when he courageously stated: “I believe that the entire effort of modern society should be concentrated on the endeavor to outlaw war as a method of the solution of problems between nations.”

    It is now that moment, in the history of our country, at this place in time, to speak out, peacefully protest, write and stir the spirit of this country.

    “May we never confuse honest dissent with disloyal subversion.”
    – Dwight D. Eisenhower.

    “War will exist until that distant day when the conscientious objector enjoys the same reputation and prestige that the warrior does today.”
    – John F. Kennedy.

    **As published in the Tribune-Democrat on December 06, 2009 12:42 pm

  • A Call to Action – The Pediatricians of Pennsylvania – Support for the large population based public health approach to bullying prevention – the Pennsylvania Model

    In 2006, the Highmark Foundation of western Pennsylvania launched the Healthy High 5™ initiative, and partnered with the Center for Health Promotion and Disease Prevention, at the Windber Research Institute; Pennsylvania Deptartment of Education, and Clemson University to address school-based bullying on a large scale, utilizing the Olweus Bullying Prevention Program (OBPP). By 2012, this project will reach approximately 230,000 out of 1,775,029 school children in Pennsylvania (13% of the total student population), 442 out of 3,280 school buildings (14% of all schools), more than 17,000 teachers, and over 340,000 parents. This is the largest implementation and evaluation of the OBPP in the U.S. In fact, approximately one third of all U.S. students who have taken the Olweus Bullying Questionnaire reside in Pennsylvania. Based on the work at the Windber Research Institute our state wide data now allows us to offer preliminary comment on the cost effect of a large population bullying prevention initiative. The Pennsylvania implementation of OBPP reduces mental health costs in children and adolescents by $9 million. Other health consequences that will be included in the cost effect analysis are alcohol and substance abuse, abdominal pain, headache, and psychosomatic symptoms (i.e. vomiting, bedwetting, sleep disturbance, poor appetite). And this is only with three years of implementation.

    In January 2011, Dr. Susan Limber, of Clemson University’s Institute on Family & Neighborhood Life analyzed nearly 113,000 Olweus Bullying Questionnaire (OBQ) responses, the standard measurement tool of the OBPP. These students, from grades 3-12, represent 225 Pennsylvania schools. Positive changes were seen across almost every OBQ category, including bullying prevalence, types of bullying, duration of bullying, students’ feelings and attitudes about bullying, and students’ reactions to bullying. Specifically, after two years of OBPP impmentation, our data analyis has shown that there are fewer student reporting that they are being bullied ( a relative reduction of 10%-13%) and fewer students reporting they had bullied others (a relative reduction of 27%-41%).  Out of the 230,000 Pennsylvania students our initative will reach, as a result of our efforts conservatively 23,000 fewer students will be bullied, and 62,100 fewer students will bully others.

    The Highmark funding has allowed for both large population implementation as well as a strategic continuing education process inclusive of local and regional onsite educational events, training and professional web educational opportunities. I have taken excerpts from the formal observations made by Susan Limber, PhD Clemson University on the national Impact of Highmark Funding for the Olweus Bullying Prevention Program

    • ‘Highmark funding provided the resources needed to develop the trainer recertification process (which includes a 2-day face-to-face training and on-line learning modules) and pilot the process in Pennsylvania.  The recertification process began in 2009 in Pennsylvania and has been free to all PA trainers.  The process was opened nationally to all eligible OBPP trainers in 2010.”
    • “We have been able to adapt Olweus International’s Quality Assurance System (which was developed for use in Norwegian schools) for use in the American school context.  This process, which is currently being piloted in Pennsylvania schools, involves the establishment of clear quality assurance standards, the coaching of trainers to aid schools in meeting these standards, documentation and site visits to monitor fidelity and progress, and an opportunity to correct any deviations from fidelity.  Schools that successfully complete this process may proudly declare themselves “Olweus Schools”.  The pilot process in Pennsylvania will be invaluable in helping us fine-tune this procedure, which we anticipate will significantly increase the motivation and abilities of school personnel to implement the OBPP with fidelity across the US.”
    • “We were able to convene a national working group consisting of trainers who have experience in implementing the OBPP in high schools.  This group examined the extent to which elements of the OBPP had been modified for use in high schools and collected ideas and resources to assist schools in implementing the OBPP effectively.  The culmination of this group’s work has yielded:  (a) revised training materials (PPT slides and agendas) for use in training high school Bullying Prevention Coordinating Committees, (b) an annotated list of suggested supplemental resources and curricular support materials for high school personnel implementing the OBPP, and (c) a tip sheet for educators and family members to assist them in discussing bullying with teens.  These resources will be invaluable tools for trainers in Pennsylvania and across the US who are interested in implementing the OBPP in high schools but currently lack the program supports to do so.”
    • “Schools have dramatically different levels of success in meaningfully involving parents in OBPP planning and activities.   We have made needed revisions to the OBPP Workbook, the key planning tool for implementation of the OBPP.  These revisions include a much heightened focus on engaging parents in various levels of the OBPP.  These training materials will be available to trainers within Pennsylvania and across the US.”
    • (The Pennsylvania initiative allowed ) “us to analyze the data in the OBQ database, we would have been much delayed in producing and releasing these important (national) findings.”

    And from one of our PA school district superintendents: “We are proud of the positive impact the HALT! (Olweus) program has had on our district and community. In 2008-09, there were over 60 teacher assaults in a particular high school with two teachers seriously injured, in addition to 333 expulsions. In 2010, there were zero expulsions.” And in Cambria County 30% of participating elementary and middle school students now report that they have a friend, when they previously did not.

    In addition, and in collaboration with Professors Olweus and Limber, the PA Coalition has implemented multiple layers of Evaluation, The Olweus Bullying Questionnaire, Online Surveys for HALT!-Teacher, Parent and School Support Staff,  Integrated Teacher Survey, School Level Fidelity Report, Integrated BPCC Coordinator Evaluation Survey, and the Readiness Series for Prevention of School Violence

    We feel that this PA initiative can serve as model program for other states that want to deliver an internationally recognized bullying prevention initiative at low cost to a large population of students and with the highest level of programmatic fidelity, monitoring and evaluation. We need to approach these public health/social epidemics from a public health perspective rather then from only a school or district setting so as to gain maximum behavior and health impact; with the appropriate monitoring and evaluation; and in a cost effective manner where it can later be stated that the initiative has been identified as a legitimate cost benefit to society, especially now during these difficult economic times. Many thanks.

  • Why a blog?

    I look forward to sharing my experiences from the world of health. As a Board Certified Pediatrician and Public Health Professional, I view health from a more systematic perspective.I will begin to post about my current national and international work, overall health promotion, and issues that appear in the media.

    My current activities:

    • School-based bullying prevention-My team and I are responsible for the largest implementation of the Olweus Bullying Prevention program in the U.S. which was made possible through a private health foundation.
    • WHO Health Promoting Hospitals -I am a member of the WHO-HPH Governance Board and am working with a hospital in Italy regarding pediatric asthma.
    • Medical Home development at several hospitals throughout the country
    • Establishment of undergraduate Public Health Curricula
  • Bullying – yes, a lot of talk, but action

    When the media does get involved in an informed manner they are able to successfully make that statement to inform the public of where we are and where we should be regarding that “social issue.” Thomas Sowell, from the Hoover Institute based in Stamford, California and a frequent contributor to the Tribune Democrat national newspaper system did that for us in his April 25th piece on bullying, “A lot of talk about bullying, but little action.” In many ways he is correct. Politicians, alone or educators, alone, often have less then adequate results in any singular attempt to reduce bullying in our schools. What will work and what has been demonstrated to work is a public health approach to the issue. Bullying is a complex social epidemic. First, there should be no question that it is at epidemic proportions when upwards of 30% of our children are involved in bullying on any given school day. Also, the health and legal issues related to bullying adds another layer of activity to that epidemic. It costs all of us when that child is seen in the physician’s office or emergency room with a health issue, small or significant, related to bullying or when we can now document increased criminal activity in adulthood when a child becomes a bully in his youth.

    It is not only the politicians, media or educators that need to step up to the plate and act. Our managed care organizations and health care providers must appreciate the health consequences of bullying beyond that of the school based bullying event. Health care reform needs to involve all the players at many levels. The Academy of Pediatrics and similar national organizations must appreciate the “evidence” of evidence based programs. Though not having their origins in the United States these internationally recognized initiatives have been evaluated over the decades and to now hold these programs to another level of ill defined evaluation allows us never to get out of the gate to do something about the issue. Judges and lawyers need to imbed a “public health” foundation into their unfunded policy mandates and not just require, reprimand or punish the student or school. Monitored, evidence based programs need to be part of the equation.

    It is a complex issue requiring the theories and practices of public health science to implement that evidence based program with the highest of fidelity, monitor and evaluate the effort and, lastly, but most importantly, enable and empower those educators, politicians, health care providers, etc to sustain the initiative beyond the initial funding or programmatic activity.

    An example of this public health approach and the only such example in the United States is what has occurred in Pennsylvania. The Highmark Foundation, in partnership with their health care organization, Highmark, Inc, and in realizing the health and social consequences of school based bulling, developed a coalition of educators, public health professionals, program specialists and other key partners to strategically address the issue. This five year effort has resulted in the largest U.S. implementation and evaluation of an internationally recognized bullying prevention initiative. The $ 9 million dollars did not come from the government, CDC or some other nationally recognized organization, but from a regional foundation that wanted to develop that program to assist their clients. Along the way they developed a national model – – action, not talk. In this coalition driven initiative involving approximately 250,000 children, 400 schools and thousands of teachers, parents, school bus drivers, and lunch room monitors bullying rates have decreased along with increased adult and bystander involvement. We are now reporting out on these positive findings as well as demonstrating the cost benefit to the health care system, the educational system and society. Thus, the action taking place in western Pennsylvania resulted in a comprehensive public health initiative involving an evidence based program; a large population; program implementation with high fidelity; extensive monitoring and evaluation to the point of evaluating not only a decline in bullying rates but other behavioral and health enhancements as well as a cost benefit to many segments of our society. It is certainly a confirmed call to action.