Best city for geezers? NY lays claim

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New York City seems to be all aglow in being named by the World Health Organization to its Global Network of Age-friendly cities. As Clyde Haberman reported about the event in the July 1 New York Times,

“It makes us members of a club of people who are struggling, in their own and perhaps much different ways, with learning about and thinking about and approaching this issue,” said Linda I. Gibbs, the deputy mayor for health and human services. “It’s really a lovely recognition.”

One reason for the acknowledgment was a plan that city officials and the New York Academy of Medicine announced last year to improve life for older New Yorkers. All sorts of ideas were put forth, on matters like transportation, housing, health care, job training, nutrition and cultural activities. To a large degree, it was more a wish list than a concrete program. But at least it showed that the city was thinking about issues that will only become more dominant.

Like other cities, New York has a population that is aging, if you will forgive a somewhat meaningless word that we are stuck with. After all, everyone is aging. It’s called living. The only people not aging are dead.

WHO says, of its Global Nework of Age-friendly Cities, that the problem lies with the fact that too many of us are aging and not dying.

Populations in almost every corner of the world are growing older. The greatest changes are occurring in less-developed countries. By 2050, it is estimated that 80% of the expected 2 billion people aged 60 years or over will live in low or middle income countries. The Network aims to help cities create urban environments that allow older people to remain active and healthy participants in society.

To that end, the Network got off the ground a few years ago, and now lists a few cities across the globe as having been accepted for membership. This week’s bulletin (excerpted above and below) lists the Big Apple as the first U.S. member, although the PDF of member cities also lists Portland, and one has to wonder how Portland’s going to feel about all of New York’s hoopla.

The WHO Age-friendly Cities initiative began in 2006 by identifying the key elements of the urban environment that support active and healthy ageing. Research from 33 cities, confirmed the importance for older people of access to public transport, outdoor spaces and buildings, as well as the need for appropriate housing, community support and health services. But it also highlighted the need to foster the connections that allow older people to be active participants in society, to overcome ageism and to provide greater opportunities for civic participation and employment.

The Global Network builds on these principles but takes them a significant step further by requiring participating cities to commence an ongoing process of assessment and implementation. Network members are committed to taking active steps to creating a better environment for their older residents.

A few years ago (2006) the Sperling’s Best Places people came out with a “Best Cities” list about which do the best job of caring for their aging folks. The “Best Cities for Seniors” study examined the state of senior care in the 50 largest metropolitan areas in the United States.

“This is different from the usual studies of retirement living,” said Bert Sperling, the study’s primary author. “When we first retire, we have the energy for traveling and sightseeing. At some point, we will all need specialized resources and facilities to help us cope with aging. That’s what this study examines.”

This unique new study, produced in partnership with Bankers Life and Casualty Company, identifies cities that offer the best resources for less active seniors. The study analyzed nearly 50 categories such as various senior living facilities, comprehensive medical care, specialized transportation services, and a significant senior population.

Top Ten Cities for Seniors

  1. Portland, OR
  2. Seattle, WA
  3. San Francisco, CA
  4. Pittsburgh, PA
  5. Milwaukee, WI
  6. Philadelphia, PA
  7. New York, NY
  8. Boston, MA
  9. Cincinnati, OH
  10. Chicago, IL

Haberman takes issue with that ‘Senior’ word along with the ‘aging’ word. “What does that make the rest of the populace — juniors?” This space (an unabashed fan of Sperling’s #3 city — sorry, #7; but you’re my #2) concurs. But Great Geezer Towns probably wouldn’t cut it with WHO.

Alcohol fee = 'cause for harm' money: A funding idea whose time has come

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Booze, it seems, causes some people to do drunken things, get in trouble (i.e., do harm, at times), go off to the E.R., occasionally in an ambulance. So why not tax the booze to pay for the E.R. and ambulances? This is being proposed by San Francisco Supervisor John Avalos in one of a bunch of efforts to fill the gaping budget hole that this city, like virtually every city in the nation, is facing.

It is called a “cause for harm” fee. A fee, explains San Francisco Chronicle columnist C.W. Nevius, differs from a tax because it can only be spent for the specified purpose for which it was collected. We don’t like the word Tax these days.

No fair! say the bar and restaurant owners; five cents more per martini will kill the business! I doubt that. Having put in my time as a martini (among other things) drinker, I can absolutely certify that if you want a$6 cocktail you’re not going to pass it up at $6.05.

“Cause for harm” fees, in fact, seem like a pretty good idea:

  • Oil company digging fees (say, five cents a quart) for spills, etc.
  • Leaf-blower fees to mitigate noise, air and clogging-the-storm-drain pollution
  • A dead cell phone fee to ship dead cell phones to another planet if there’s one that wouldn’t really mind
  • Pigeon fees… well, just because

You can create your own list. Fees of this “cause for harm” type are collected in other states, though more often used to pay for things like treatment and education rather than transportation to the ER. In any event, they clearly make sense. And somehow the cause/effect principle seems like one that should pick up wider support.

Maybe Mr. Karzai could impose a few fees of his own, and use them to send all those troops back home.

Supervisor’s fee on alcohol a terrific idea.

Grim outlook for public transportation

Muni-Bus-Market-street-San-Francisco
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Can we have a functional, effective transportation system in the U.S.? Can we afford not to? Those were the questions addressed by former Secretary of Transportation Norman Mineta and a panel of experts at a full-house 9 AM event at San Francisco’s Commonwealth Club Friday. Oh — and how are we going to pay for it all? The program was titled “Funding the Transportation System of the Future.”

“Within the next two decades,” Mineta said in his introductory remarks, “the Census Bureau estimates that the U.S. population will increase by as many as 50 million people. This population growth, combined with a growing backlog of overdue maintenance work on roads and transit systems, creates a need for significantly expanded transportation revenues. However, the current political climate is generally unfavorable to tax increases.”

The ensuing discussion continually returned to two general points: first, that our parents and grandparents funded the transit infrastructures and systems we now enjoy and it is incumbent upon us to do the same for our children and grandchildren; and second, as Mineta and others repeatedly said, that there is no political will anywhere to do the latter. One illustration of the first point was cited by panelist William Millar, president of the American Public Transportation Association, who observed that “the New York subway system was built 106 years ago for $35 million — and you couldn’t get a feasibility study today for $35 million.”

Given the fact that most cities and counties could spend $35 million on overdue maintenance alone, most panelist comments and audience questions concerned the issue of finding funds at a time when tax increases are not very popular. “Creative funding” solutions appear to be the answer, even if there is currently far more creativity around than funds.

Asha Weinstein Agrawal, Director of the Mineta Transportation Institute‘s National Transportation Finance Center, cited a public opinion poll released yesterday (“one of those phone calls at dinner time…”) that surveyed 1500 people in English and Spanish to test receptiveness to eight variations of a possible gasoline tax. In general, opposition to such a tax is high, she said, but acceptance increases in proportion to benefits which individuals can see: tie the tax to emissions per vehicle and thus reduce greenhouse gases, for example. Agrawal recommended consideration of taxes linked to environmental effects.

Panelist John Horsley, Executive Director of the American Association of State Highway and Transportation Officials, said that because of funding cuts and declining revenues (from road usage fees etc), the U.S. Highway Fund will be insolvent some time between August and October of 2011, with the resultant loss of approximately 1 million jobs. He cited a few bright spots such as several states going ahead with high speed rail projects, “four states have actually raised gas taxes, Kansas has increased the sales tax, and New Hampshire sold itself a bridge” (which will get paid off through tolls.) High occupancy toll lanes were another potential funding source Horsley said could help until “fiscal sanity returns: investing in something good (rather than) borrowing forever.”

The consensus was aptly covered in one summation by California Senator Alan Lowenthal: “It’s a very difficult time for transportation.”

Whereupon this reporter got back on the #1 California Muni bus (catch a back seat, work on your computer for 30 minutes, no parking fee, no traffic hassle) and went home.

Cell phone radiation danger: true or false?

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Head-zaps, otherwise known as cell phone radiation levels, messing with your brain? Nobody knows. What we do know is that cell phones emit radiation, just as radio and TV stations do at somewhat higher levels. What we also know is that nobody cares much. The back-and-forth going on between legislators and cell phone industry lobbyists suggests that a few people do care… but it’s a long road from caring to understanding to any kind of meaningful action.

In California, where local and state efforts to increase information made available to consumers have met with mixed results, an explanation in the Letters section of today’s San Francisco Chronicle offers some interesting perspectives. To understand them, it helps to know about the city’s Sutro Tower (above), a looming structure completed in 1973 and now furnishing transmissions for 11 TV stations, 4 FM radio stations and about 20 wireless communication services.

Local electrical engineer Bill Choisser has this to say:

The power of radio waves falls off as the square of the distance. This means one watt an inch from your head (typical for a cell phone) has the same effect as 1 million watts 1,000 inches from your head. The strongest TV signals on Sutro Tower run i million watts. A thousand inches is about 83 feet. Whether putting your head 83 feet from Sutro Tower every time you talk on the phone bothers you, is up to you.

San Francisco’s board of supervisor’s voted last week to require disclosure of the measure of cell phone radiation next to sales displays, something unlikely to make the tiniest bit of difference to sellers, buyers or anyone else. The FCC has a similar requirement likely to make even less difference.

CNET’s Christina Jewett, on her California Watch blog, summed up some of the action at the state level, where Sen. Mark Leno‘s bill to make radiation level information more accessible recently died. Leno emphasizes, in a statement on his website that there’s no definitive evidence that cell phone radiation causes cancer or other illnesses. Supporters argue that there are potential health effects dangerous enough to warrant making more information available, Jewett explains, while opponents termed the whole business expensive and unnecessary.

When the bill was a going concern, it did little to slow the never-ending party that lobbyists for AT&T Inc., one of its chief opponents, tend to host at Arco Arena. The firm spent about $535,000 on lobbying during the first quarter of this year. From Kings games to Disney Stars on Ice to a Valentine’s Super Love Jam, legislative staffers continued to enjoy the hospitality. (Details below).

Whether the lobbying effort led to the bill’s demise may never be known. But the debate at least is bringing out more information on the issue, one that regulators and scientists pledge to keep watching.

Given the number of Americans walking around (or sitting, or standing in place) with cell phones plastered to their ears, I for one am happy that somebody is watching… and that Bill Choisser is explaining.

State hangs up on expansion of San Francisco phone law | California Watch.

Your doctor's in shape… but may just be getting in shape to retire

U.S. doctors as a group are “leaner, fitter and live longer than average Americans… male physicians keep their cholesterol and blood pressure lower… women doctors are more likely to use hormone-replacement therapy than their patients,” according to several recent surveys.

That’s the good news.

The bad news is that they are taking all this health and fitness into early retirement. And thanks to the hordes of baby boomers hanging up their stethoscopes for good, finding enough doctors in any shape at all is going to be a challenge, particularly in light of the numbers of newly insured.

Nearly 40 percent of doctors are 55 or older, according to the Center for Workforce Studies of the Association of American Medical Colleges. Included in that group are doctors whose specialties will be the pillars of providing care in 2014, when the overhaul kicks in; family medicine and general practitioners (37 percent); general surgeons (42 percent); pediatrics (33 percent), and internal medicine and pediatrics (35 percent).

About a third of the much larger nursing workforce is 50 or older, and about 55 percent expressed an intention to retire in the next 10 years, according to a Nursing Management Aging Workforce Survey by the Bernard Hodes Group. New registered nurses are flowing from colleges, but not enough to replace the number planning to leave the profession.

“Moving into the future, we see a very large shortage of nurses, about 300,000,” said Peter Buerhaus, a nurse and health-care economist and a professor at Vanderbilt University. “That number does not account for the demand created by reform. That’s a knockout number. It knocks the system down. It stops it.”

According to the census, baby boomers include the 66 million Americans born between 1946 and 1964.

In an article for the Journal of the American Medical Association, Buerhaus and colleagues Douglas Staiger and David Auerbach predicted that there will be at least 100,000 fewer doctors in the workplace than the 1.1 million the federal government projects will be needed in 2020 under the health-care overhaul.

“There’s a much more rapid retirement of physicians,” Buerhaus said. “What does this retirement mean? This will mean at least 100,000 fewer doctors in the workplace in 2020.”He said the article does not estimate the change in demand or the level of recruitment by medical colleges, which is being beefed up significantly under the health-care law.

Although current studies involve more than a little conjecture — Will professions in the medical field continue to be as attractive as other areas? Will doctors and nurses work longer if truly needed? — there is no doubt about the coming shortage.

Lori Heim, president of the American Association of Family Practitioners, said someone might soon have to replace her. “My age group is looking at when we are going to retire,” said Heim, who is 54. “More physicians are changing their practice, doing things that have less calls. They want administrative roles.”

Heim said her statement is based on an impression. “I haven’t seen any numbers on this.” But, she said, her association is among the many that for years have pointed out the shortage of primary care doctors and nurses to the White House and Congress.

Staying healthy might be the best defense.

Retirements by baby-boomer doctors, nurses could strain overhaul.

New 'morning after' pill meets opposition from abortion foes

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With global overpopulation among the most critical problems of the 21st century, news of a highly effective contraceptive becoming available in the U.S. would seem very good news indeed. But as health writer Rob Stein reports in the Washington Post, it may not happen:

A French drug company is seeking to offer American women something their European counterparts already have: a pill that works long after “the morning after.”

The drug, dubbed ella, would be sold as a contraceptive — one that could prevent pregnancy for as many as five days after unprotected sex. But the new drug is a close chemical relative of the abortion pill RU-486, raising the possibility that it could also induce abortion by making the womb inhospitable for an embryo.

Plan B (the last emergency contraceptive vetted by the FDA), which works for up to 72 hours after sex, was eventually approved for sale without a prescription, although a doctor’s order is required for girls younger than 17. The new drug promises to extend that period to at least 120 hours. Approved in Europe last year, ella is available as an emergency contraceptive in at least 22 countries.

“With ulipristal (ella), women will be enticed to buy a poorly tested abortion drug, unaware of its medical risks, under the guise that it’s a morning-after pill,” said Wendy Wright of Concerned Women for America, which led the battle against Plan B.

Plan B prevents a pregnancy by administering high doses of a hormone that mimics progesterone. It works primarily by inhibiting the ovaries from producing eggs. Critics argue it can also prevent a fertilized egg from implanting in the womb, which some consider equivalent to an abortion.

Ella works as a contraceptive by blocking progesterone’s activity, which delays the ovaries from producing an egg. RU-486, too, blocks the action of progesterone, which is also needed to prepare the womb to accept a fertilized egg and to nurture a developing embryo. That’s how RU-486 can prevent a fertilized egg from implanting and dislodge growing embryos. Ella’s chemical similarity raises the possibility that it might do the same thing, perhaps if taken at elevated doses. But no one knows for sure because the drug has never been tested that way. Opponents of the drug are convinced it will. “It kills embryos, just like the abortion pill,” said Donna Harrison, president of the American Association of Pro-Life Obstetricians and Gynecologists.

A federal panel will convene this week to consider endorsing the drug. Those favoring approval are worried that the ambiguous sentiments, and the power of abortion foes who seem poised to weigh in against it, will influence the outcome.

“FDA should be a ‘Just the facts ma’am’ organization,” said Susan F. Wood, an associate professor at the George Washington University School of Public Health and Health Services who resigned from the FDA to protest delays in making Plan B more accessible. “I’m hoping the FDA will take that position.”

There is an great unmet need out there for emergency contraception that is effective as this for so long,” said Erin Gainer, chief executive of HRA Pharma of Paris. Studies involving more than 4,500 women in the United States and Europe show that ella is safe, producing minor side effects including headaches, nausea and fatigue, she said.

The company has no plans to test ella as an abortion drug, but it did not appear to cause any problems for the handful of women who have become pregnant after taking the drug, she said.

“The people who are opposing this are not just opposed to abortion,” said Amy Allina, program director at the National Women’s Health Network. “They also opposed contraception and they are trying to confuse the issue.”

Back to the issue: the planet has a finite amount of space for human beings. When one human being (and often two human beings acting as one) seeks not to add an unwanted human being, would it not make sense to furnish all available safe, legal tools to assist in that humanitarian effort?

Stay tuned for the answer from the FDA.

New ‘morning-after’ pill, ella, raises debate over similarity to abortion drug.

Your arteries know your REAL age

1.11.09: CHD, here we come!
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Heart attacks, strokes and a long list of other artery-related afflictions top the list of health risks for the 50-and-over population — and a rising number of those even younger. So figuring how old you really are is an increasingly big deal. If your history includes cigarettes and fast food in abundance you might not want to know. But your arteries hold important information.

Wall Street Journal writer Ron Winslow reports on the intricate business of determining your vascular age — and why that’s an important determination to make.

Several tools are available that enable doctors and patients to calculate vascular age. These suggest there can be a substantial difference between how old you are and how old your blood vessels are. For instance, the vascular age of a 35-year-old man who smokes and has diabetes, high blood pressure and abnormal cholesterol could be as high as 76 years old—more than double his chronological age, according to a recent study. The arteries of a 30-year-old woman with similar risk factors could be equivalent to those of an average woman who is more than 80 years old.

Such a calculation “gives a sense that your risk-factor burden is making you age faster than you think you are,” says Donald Lloyd-Jones, a preventive cardiologist at Northwestern University, Chicago, who co-authored the recent study, which appeared in the journal Circulation last August. “The more you can make it concrete, the better you can impart information about risk.”

The good news, doctors say, is that by taking steps to reduce risk factors and the damage they inflict on arteries, it is possible to turn back the clock on vascular age.

Some of us — long-time smokers, members of a family with genetic problems that can’t be overcome — might not be able to access the good news. But many can, and for them, a few changes in lifestyle, or manageable medications, can make a lifetime of difference.

  • A 42-year-old man who smokes and has total cholesterol of 180, good cholesterol (HDL) of 45 and systolic blood pressure of 125, has a vascular age of a 54-year-old. If he quits smoking, his vascular age could drop to 42, the same as his chronological age.
  • A 52-year-old nonsmoking woman, who has total cholesterol of 220, HDL of 44 and systolic blood pressure of 135, has a vascular age of a 68-year-old. If the woman reduces her cholesterol below 200, her vascular age could drop to 59 years old.

If you’re feeling your age today, maybe your arteries are trying to tell you something.

Arteries Can Reveal Your Risk of Heart Disease – WSJ.com.

Guns, drugs & sit/lie laws: who's got the real rights?

Discussions stirred up by the comments in this space a few days ago (see below) concerning gun rights v public safety rights ranged from the specifically pro-gun and pro-open carry (“citizens use firearms for self-defense between 150,000 and 3,052,717 times a year. The lowest estimate comes to about 410 times a day, and the highest estimate is 8,363 times a day,” says willbill; “How many times has an open carry proponent shot someone? If you use statistics rather than “from the hip” anti gun rhetoric, you will find legal gun owners are not the problem. Illegal gun owners are the problem,” says airtechjr) to the pointedly anti-gun (“Besides looking really stupid, having a gun visible – even if unloaded – is scary! Do you know how fast you can jam a clip into a Glock Automatic? 3 seconds,” says Tom Medlicott.) Emeryville, CA Police Chief Ken James says it’s 1.3 seconds.

In the long run, though, the argument is not about gun rights v public safety rights, says carlfromchicago, because I have no constitutional right to feel safe in public. And this all started because I admittedly did not feel safe while attending a panel discussion on the proposed California Open Carry ban (AB #1934 now in the state legislature) and learning that I was the only unarmed citizen within three solid rows of citizens carrying (presumably legal) concealed weapons. According to Carl,

Whether people are comfortable around guns is a very interesting and relevant social discussion. But this is not a question of two rights pitted against one another. As much as we all want to feel safe, it’s simply a frame of mind. The right you have is to think what you wish, and feel what you wish … but that compels no one, or the government, to ensure what you think or what you wish becomes reality for everyone.

This brings us to San Francisco’s currently proposed sit/lie ordinance. It says (more or less) you may not sit or lie on the sidewalk. It means, please get the drug pushers and increasingly obnoxious defecators-on-front-steppers out of the ‘hood. It arose out of frustrations in San Francisco’s famously tolerant Haight Ashbury (remember the 60s?) neighborhood where things recently have gotten somewhat out of hand.

This space is a strong supporter of humane treatment and expanded rights for homeless. Countless local and national programs, some good, some better, are in place and worth everyone’s attention; I try to make regular, teeny contributions of time and resources. But should I have the right to walk along Haight Street in broad daylight without tripping on a soiled, zoned-out kid whose dog is only loosely tied next to him? That’s the question. And should we now have a law enabling law enforcement officials to wake him up (if possible), move him along or toss him in the paddy wagon to be deposited in a jail cell? That may not be the answer. Either way, it is generating great heat and not a lot of light in my beloved hometown.

San Francisco is not alone in this dilemma. City Watchdog blogger Melissa Griffin, on her Sweet Melissa blog, reports having dug up a report (“Big pdf here,” she warns) on “Homes Not Handcuffs: The Criminalization of Homelessness in U.S. Cities.”

The report surveyed laws in 235 cities (including San Francisco) and made some interesting findings:

  • 30 percent prohibit sitting or lying in certain public places.
  • 47 percent prohibit loitering in certain public places and 19 percent prohibit it citywide.
  • 47 percent prohibit begging in certain public places; 49 percent prohibit aggressive panhandling; and 23 percent have citywide prohibitions on begging.

At almost 200 pages, the report provides an exhaustive discussion of the legal landscape in 90 cities. Some have definitely used creative methods:

  • In Billings, Mont., it’s illegal to “aggressively solicit” and/or lie about being “from out of town, a veteran, disabled or homeless” while asking for money.
  • In Boerne, Texas, all panhandlers have to buy a license to solicit (like other solicitors and vendors) at a cost of $115. Durham, N.C., charges $20 for a panhandling permit.
  • Las Vegas, briefly had a law that prohibited sleeping “within 500 feet of a deposit of urine or feces.”

I am getting right back on the fence. Public safety does seem to me both an appropriate issue for discussion and an individual right. How far it can be legislated (there are over 20,000 gun laws already on the books across the country, uncertain wrote in) is debatable. I still wish guns would just go away. I don’t know what to do about obnoxious sitters/liers upon the sidewalks. Both seem obstacles to the peaceful communities some of us have in our memories and all of us have in our imaginations.