10.8.07

 Starting this Friday, the Yale Public Health Coalition will be holding its first-ever Health Care Access Week to raise awareness and to advocate for the university to take a larger role in public health. You’ll soon see table tents in the dining halls and posters on billboards, but there’s one thing you won’t see: a banner across the Porter Gate on Cross Campus. For as long as I can remember, banners have been a symbol of the vibrant student life here at Yale. Colorful and eye-catching, they would advertise everything from a cappella concerts to cultural nights, and in our hyper-busy world, they were the perfect way to reach out to the entire campus community. But this year, after a new set of warnings and fines from Dean Edgar Letriz, our long tradition of banners across campus has all but disappeared.

The administration has cited campus aesthetics as the primary reason for this new enforcement, but are banners really a problem? Isn’t an active student life part of what makes Yale so special? Since when did our college architecture become reduced to some sort of museum object for college view books?

The cranes on cross campus, not the banners, seem like a bigger obstacle to me. Perhaps I should start fining Yale for each day that one of its blue tarps gets in the way of my appreciation of the campus and use the money to support student groups whose banners I find more appealing.

Practically speaking, this crackdown on banners may actually do more harm than good to the campus environment. In the first month of the banner ban, students seem to be using more flyers on already overcrowded billboards, which wastes paper, and chalking on all parts of campus, which is harder to clean up.

By far, the gravest consequence of the banner ban is the inhibition on our freedom of speech. It seems a bit ironic that we are encouraged to think outside the box in the classroom, but in the courtyard, we are confined to the bulletin board.

According to the News, the administration is considering allowing banners if they can find a way to prevent them from detracting from the campus’s visual appeal. Yet the proposals they offer are absurd. The Head of Yale Recycling, CJ May, is quoted saying, “One idea is to have a contest to see what is the most aesthetically pleasing way [of using banners] … Something like the slightly bent banners at Dunkin’ Donuts or a row of flags on Cross Campus could be beautiful and allow students to be more expressive.” Since when did we start comparing Yale University to Dunkin’ Donuts?

As a public health columnist, I am addressing this issue because freedom of speech is a fundamental precondition for progressive action. C-E.A Winslow, the founder of the Yale School of Public Health, describes the mission of public health as one of “organized community action.” But how can we organize if we can’t advertise?

In recent months, freedom of speech has come under attack at college campuses across the country. Last month, a student at the University of Florida was Tasered by the police for insisting on asking a long, political question to Senator John Kerry at a rally. Earlier this summer, the Supreme Court ruled against a student who put up a sophomoric sign that read “Bong Hits 4 Jesus.” If school administrators are allowed to ban whatever does not fit into the expected aesthetic, then how can freedom of speech truly exist?

Last week, Nicholas Handler ’09 wrote in his prize-winning New York Times essay, “The Posteverything Generation” that “College as America once knew it — as an incubator of radical social change — is coming to an end.” In the age of iPods, he suggests that the grounds of universities are not enough to incubate change and that, in the 21st century, activism will be relegated to the internet and the faceless digital world.

Handler’s critique goes too far, however, and a case study of our own campus proves it. Events like Health Care Access Week show that students from different groups on campus can come together to make change in our community. We are not running out of common spaces on campuses because of a lack of ideas or passions. We are running out of common spaces because some bureaucrats are too concerned about their horticulture.

In 1969, Supreme Court Justice Abe Fortas, LAW ’33, famously wrote in the Tinker v. Des Moines School District decision about students protesting the Vietnam War that neither teachers nor students “shed their constitutional rights to freedom of speech or expression at the schoolhouse gate.” Forty years later, the Noah Porter Gate at Fortas’s own university should be no exception.

Robert Nelb is a senior in Timothy Dwight College. His column usually runs on alternate Tuesdays.

Making change is a difficult business. Two weeks ago, I wrote about the importance of reauthorizing the State Children’s Health Insurance Program, but on Thursday, President Bush again promised to veto the bill, citing the same false statistics that I criticized in my op-ed. Last week, I went a step further and collected petition signatures for a better farm bill that would address obesity in the U.S. and help farmers in developing countries, but the Senate’s new draft bill still fell short. Now, this week, I fear that my lone voice will again fall on deaf ears.

You know the feeling. Perhaps you wrote a 20-page paper about a great new policy idea that only your professor read, or maybe you traveled halfway around the world to help others only to find that a week of service wouldn’t really solve any problems. You probably learned something in the process and you may have gotten another accolade to add to your resume, but in the end, the problems are still there. This feeling of powerlessness is frustrating for any young idealist, and I’m no exception.

So this week, I want to focus on a topic on which I know I can make some headway — strengthening our community here at Yale and in New Haven. It may not be as grandiose as saving the world, but I bet that if you and I and the rest of our community start working together a bit better, we can start seeing some real change.

Making change here in New Haven is the first step, I feel, to making change across our country and even around the world. Yale is a global university that sets standards for others to follow, and New Haven is a community facing issues of inequality that are all too common in this world. If we can’t build a more equal and just society here, then how can we expect to do the same anywhere else?

Unfortunately, we have a long way to go to reduce health inequalities in New Haven. New Haven residents as a whole are at a higher risk of poor health outcomes, such as infant mortality, when compared to the rest of Connecticut and the U.S. This summary statistic, however, masks the larger disparities between different races and ethnicities. Earlier this month, the Connecticut NAACP released its own report about the disproportionate burden of disease for blacks in Connecticut, even after controlling for income. These disparities are unacceptable for any city, but they are particularly striking for our city.

New Haven has the resources to make change, but too often it falls short because of artificial barriers that we erect between town and gown and even within the University. We all want to be leaders and we all have our pet projects, but rarely do we try to work together. Just looking at Yale College: With more than one student group for every 20 students, there are so many leaders on campus that it’s hard to understand how anything gets done. In our quests for excellence as individuals and as an institution, we neglect the community around us.

Despite these historic barriers, some groups in the community are stepping up to start bridging this divide. Last spring, the new Community Alliance for Research and Engagement was formed to bring together community leaders and Yale scientists to help translate the results of Yale research into positive health gains for the community. This summer, leaders from nonprofits across New Haven came to Yale to discuss shared goals, and this fall, CARE plans to expand its efforts in the community by sponsoring a total of $100,000 in grants for innovative community-based research.

Students, too, are stepping up to the plate. This Saturday, the new Yale Public Health Coalition will hold its first-ever coalition meeting to bring together more than 40 different public health groups on campus to set a common agenda for the coming year. Later this semester, a wide range of events is already being planned to raise awareness of public health issues and start making tangible changes. By focusing on coordinating existing efforts, we can do much more than any one group could do alone.

The need for this kind of coordinated community action is perhaps best summarized in a Gwendolyn Brooks quotation that the CARE program takes as its motto: “We are each other’s business, we are each other’s magnitude and bond.” We may each have our specific goals, but our fates are inextricably tied. You and I alone can’t make a difference, but we together can start changing the world.

As the debate heats up in Washington over the reauthorization of the State Children’s Health Insurance Program (commonly known as S-CHIP), one statistic has been notably missing — according to the Kaiser Family Foundation, as many as three out of four uninsured children are already eligible for state health insurance, but they are just not enrolled.

This little-known fact is crucial to finding some common ground in a polarized debate. If most uninsured kids are in fact already eligible for health care coverage, then actually providing this coverage as part of S-CHIP “expansion” will not bloat the program beyond its original intentions, as some conservatives fear. At the same time, however, if S-CHIP and Medicaid have failed to enroll more than six million eligible kids after 10 years, then simply throwing more money at the existing program, as some liberals have suggested, will have limited benefits. In the end, S-CHIP reauthorization should not be about big government or small government — it should be about good government.

Good government, unfortunately, is awfully hard to find. As a health policy student who has worked to enroll children in S-CHIP, I’ve seen in theory and practice the sly tactics used by states to discourage enrollment. Complicated forms, for example, deter those without a college degree, and face-to-face application interviews remain a barrier for parents who work multiple jobs. Sadly, there is little incentive for change since, in a cruel twist, legislators are actually left with more money in their coffers as more families are discouraged from claiming the benefits that they have been promised.

Recognizing this inherent injustice, a handful of states have been working on reform. In my home state of Pennsylvania, experience suggests that better enrollment policies can work. In 2004, Pennsylvania was one of the few states in the nation to see a decline in the number of kids enrolled in S-CHIP, but last month, after the implementation of a plan to simplify income eligibility and expand coverage to parents, the state reported record-high levels of enrollment for kids.

Unfortunately, a recent federal rule change enacted last month by the Bush administration without public comment may severely limit the ability of states like Connecticut and Pennsylvania to enroll more kids. According to the new rule, if states want to expand coverage to children whose families earn more than 250 percent of the federal poverty level, they will have to show that 95 percent of children under 200 percent of the federal poverty level are covered, a rate that hasn’t been achieved in any state. As a result, thousands of children are expected to lose health care coverage, and the underlying structural problems that prevent eligible kids from enrolling in the program remain unsolved.

Rather than pass stricter government mandates, policy-makers need to change the system to make enrollment easier. One option, called Express Lane Eligibility, proposes coordinating information that is already available through federal programs, such as Food Stamps or WIC, in order to automatically enroll children who are known to be eligible. By cutting unneeded bureaucracy, the government can reduce administrative costs and focus more resources on actually providing health care for children.

This summer, I presented a policy paper in D.C. on behalf of the Roosevelt Institution about an innovative way forward-thinking politicians could take this idea a step further. Tax information from the Earned Income Tax Credit, the federal government’s primary anti-poverty program, could be used to automatically enroll eligible kids. Studies show that almost 90 percent of eligible families with children already file the EITC’s simple form, and since eligibility requirements for the two programs are roughly the same, it makes sense to coordinate them. Families could still enroll in person, and would not be allowed to have both private and public insurance. The only difference would be that working families wouldn’t have to fill out the same information twice and that they could instead take advantage of two great programs at once. For the most technologically advanced country in the world, it is only common sense to coordinate information and get rid of redundant paper forms.

While commonsense reform is always surprisingly difficult to implement, there is a chance that it can be included in Congress’ reauthorization. Both the House and Senate bills include provisions to streamline enrollment and cover the cost of care for eligible children. Under the Senate bill, 85 percent of the additional children who would be covered are already eligible. More needs to be done, but the current bills in Congress are a good start.

As the debate heats up in Congress and as a presidential veto looms, now is the time for us as citizens to insist that good government is good policy for America’s children.

On Saturday, May 5, I’m going to the state capital to rally for universal health care. It may be the week before finals, it may be a two-hour round-trip drive, and it may not make a difference, but these details are irrelevant. Access to health care is one of the most pressing issues for our state and for our country, and so together, we must do something about it.

You all know the facts about our broken health system. On these pages, I’ve written before about the over 400,000 Connecticut residents without health insurance, about the $480 billion that are wasted each year in the U.S. health system, and about the commonsense alternatives that lie within our reach.

Today I write about action. In my last column of the semester, I want to explore how we can begin to implement fundamentally good ideas to improve the public’s health.

For one, we won’t find the answer in simply describing the problem. Statistics are important for creating evidence-based policy, but at the end of the day, having 45 million or 47 million uninsured Americans is still millions too many. The challenge is to communicate what we already know to policy-makers in order to enact real change.

Even when we turn to policy, however, it is easy to be caught in an analysis paralysis. So-called policy experts in Washington have been debating the ideal health system for years, but they can never seem to agree with one another. Instead, they tend to accentuate their differences and propagate only more confusion. Policy analysis is also important, but it is ultimately a flawed mechanism for achieving real progress.

The only solution to inaction on health care is by taking action ourselves. More groups are coming together now than ever before around the issue of universal health care, but unless a large number of voters fight against special interests and unite around a single policy, the latest efforts for national health reform will fall short, just like the last six did.

Community action sounds like a great ideal of democracy, but can it ever be obtained in our increasingly atomized society? As any Yalie knows, getting 30 students to come to an event is hard enough, let alone organizing 300 million Americans. We are all overbooked at an increasingly early age and are siphoned off into our own interest areas without concern for the larger whole. The rush at the end of the semester around final papers and exams perhaps best demonstrates this phenomenon. You probably don’t even have the time to finish reading this column, let alone attend a rally.

The springtime weather that we’ve had in recent days, however, gives me hope that all isn’t lost. For the first time in months, I saw hundreds of students taking a break from the craziness of daily life to enjoy the sun and one another. On Sunday, I had a chance to participate in the highly successful AIDS Walk with my fellow residents of New Haven, and I felt empowered that our society could find solidarity around a common cause. We all have the ability within ourselves to come together as a community, but sometimes it takes a moment of reflection to realize this.

Coming together is the first step, but what we do as a community is what really matters. In our world of increasingly entrenched and powerful lobbies, we citizens can often feel powerless. These barriers, however, should only strengthen our resolve to find innovative ways to fight these interest groups.

Students in particular need to play a leading role in effectively mobilizing people in today’s changing political landscape. Students come to the debate with a fresh optimism about the realm of the possible, and we are the most knowledgeable about new technologies for communication. The emergence of groups such as the Roosevelt Institution, the nation’s first student think tank, and of social networking Web sites for political candidates is evidence of the growing potential of our generation to influence the political process.

To make a difference, however, we students must act. I encourage you to participate in the trip to Hartford being organized by the Yale Democrats, and I urge you to help where you can with groups that are working to improve the public’s health. This summer offers us all the opportunity to step away from the grind and reconnect with the issues that are affecting our community. I’ve said it before and I’ll say it again: Together we can build a healthier world.

April is a month that separates the best from the best.

For high school seniors, this means receiving the thick or the thin envelope in what was described as one of the most competitive college admissions seasons ever. For those of us who have already been accepted, this month means going through yet another round of applications for competitive internships, fellowships and other accolades. Now, with Tap Night coming soon for Yale’s secret societies, one can only wonder when the madness will end.

Competition is not inherently bad, but it has gotten out of control. The old American Dream of simply raising a family no longer suffices. Instead, we now need a family, a Yale degree, a Rhodes scholarship, a six-figure salary and so much more. This never-ending pursuit of status symbols not only is misguided, but also results in hidden side effects for our health and that of our society.

In his book “The Status Syndrome: How Social Standing Affects Our Health and Longevity,” Dr. Michael Marmot outlines the array of scientific evidence connecting social status to health. Bosses live longer than their workers, and those with doctoral degrees live longer than those with bachelor’s degrees (even after controlling for income). Even highly competitive awards and honors may have an impact on life expectancy. A study of Oscar-winning actors and actresses, for example, shows that the winners live on average four years longer than the losers.

Before you start applying to doctoral programs and prestigious scholarships, however, take a moment to reflect on how bizarre this association is. Why should awards like the Oscars have anything to do with health?

For one, many of these status symbols aren’t inherently satisfying. Consider the recent controversy reported by the News about a pair of Harvard Rhodes scholars who were lamenting the fact that (much like other Harvard students) their decision to study at Oxford was based on name value rather than educational value. While I feel that at Yale we are fortunate to get both prestige and quality, even a Yale degree is not a guaranteed ticket to future happiness.

Even more, however, as the talented Gina Glockson learned earlier this month on “American Idol,” selection processes often are fickle, especially when you happen to be competing against Sanjaya Malakar and his “Vote for the Worst” coalition. As a result, it’s hard to postulate that there aren’t any physiological differences between the winners and losers in this game of life.

So what’s the underlying cause of these disparities? Most likely stress and anxiety, according to researchers Donald Redelmeier and Sheldon Singh, who have studied the Oscar winners. Closer investigation shows that the effect of winning the award becomes statistically insignificant for screenwriters and other professionals who are essentially forgotten in the national media buzz. The more society makes us worry about these status symbols, it seems, the greater the health consequences.

The concerns of Yalies and movie stars, however, are minimal compared to the devastating impacts that our hyper-competitiveness has on the rest of society. We at the top of the totem pole naturally think there’s no problem, but the fact is that as we set the standard for success increasingly out of reach, the gap between the haves and the have-nots also grows.

The problem of inequality remains persistent worldwide, but it is particularly acute in the United States. We say that we are a land of equal opportunity, but the statistics seem to tell a different story. The Gini coefficient, a measure of economic inequality in a country, remains significantly higher in the U.S. than in any other developed country.

Unfortunately, a high Gini coefficient is also linked to poor health. According to the 2004 Human Development Index, the United States ranks 30th in the world in life expectancy, behind Cuba, Chile and most other developed countries. The more telling statistic, however, is the fact that only three of the 29 countries ahead of the U.S. were more unequal. The problem isn’t that the poor in the U.S. are poorer in terms of dollars than the poor in other countries, but rather that the social inequality between the rich and the poor exacerbates health issues.

It’s time to end the needless suffering caused by inequality in our world. Rather than focusing on individual accolades in the zero-sum contest for social status, it’s time to turn our efforts outward toward building a community in which people can be healthy. This is not some utopian dream, but it does require a fundamentally different perspective. So, when societies come to tap with their claims of instant success, my thoughts will be elsewhere.

Before spring break, you might have overlooked an article in the News about a Connecticut high-school student with a simple but powerful plan to save the world. Jessica Adelson doesn’t have an answer to the war in Iraq or a solution to world hunger, but she does have a dream to tackle an even more deadly threat to communities in the United States and around the world: tobacco.

It’s no secret that tobacco kills. Nationwide, smoking-related deaths are close to half a million a year, which is the equivalent of three 9/11’s every single week. Smokers and non-smokers are affected, as Jessica knows firsthand from her family’s experience. What was most surprising to Jessica, however, is why many of her friends in high school, like millions across the country, continue to start smoking this addictive and destructive drug. Despite the overall decline in smoking in past decades, recent data suggest that use among high school students is on the rise.

What do we do to counter this startling trend among teenagers? Jessica offered a simple option to the Connecticut General Assembly: Raise the legal smoking age from 18 to 21.

The logic behind this proposed bill isn’t as crazy as it sounds. Tobacco kills more people each year than alcohol, so why should the legal age be any different? Other states, such as New Jersey, have increased the smoking age in recent years, demonstrating that this type of action is feasible. Given the fact that 90 percent of smokers began smoking before the age of 21, the public health potential of such an action is enormous.

Despite this potential, many have voiced criticisms using libertarian arguments of freedom of choice. As soon as the policy was proposed, R.J. Reynolds Tobacco Company argued that if citizens are old enough to fight for their country, they should be old enough to smoke. Most recently, Patrick Ward wrote in the News that 18- to 20-year-olds are responsible enough to choose whether to smoke and that unnecessary state interference would be an infringement on our personal liberties.

Yet although the decision to smoke is a personal one, it has enormous public consequences in the form of deadly secondhand smoke and an over $70 billion burden on taxpayers. Ward actually admitted that “we accept laws in … cases when they constrain individuals’ actions that would or could harm other people.” Given that tobacco kills as many as 67,500 innocent children and adults every year, it is unacceptable for us not to take stronger action.

We’re fortunate that Connecticut has taken a lead in tobacco control by increasing taxes on cigarettes and by being among the first states to ban smoking in public places. As a result of such policies, Connecticut had the fifth-lowest prevalence of smoking in the U.S. in 2005.

The fight isn’t over, however. About 18 percent of Connecticut high-school students still smoke, which is unacceptably high. We can do better, and politicians of all parties should not be afraid to stand up for what is right.

To be truly effective, however, this fight needs to continue on the national and international levels.

At the same time that Connecticut policymakers consider Jessica’s bill, Congress is making progress on a landmark bill, the Family Smoking Prevention and Tobacco Control Act, to wrestle control of tobacco from powerful tobacco lobbyists to the Food and Drug Administration. This legislation passed the Senate twice in 2004 by overwhelming bipartisan margins, but it was not enacted into law. Now it’s time to finish the job.

It is an embarrassment to our country that tobacco is one of the least regulated products on the market today. Even dog food manufacturers are required to list their ingredients, but tobacco companies are exempt from listing any of the 4,000 chemicals in cigarettes, including arsenic (rat poison) and formaldehyde. Extending regulatory capacity to the FDA offers an essential step toward taking decisive action against smoking.

Ultimately, however, we will need a more concerted international movement against tobacco. As pressure against tobacco in the U.S. has increased, tobacco companies have simply shifted their markets overseas, peddling their deadly products to the developing world.

There are currently more smokers in China than there are citizens in the United States. Globally, tobacco results in a net loss of $200 billion a year, one-third of which is in the developing world. The World Health Organization’s Framework Convention for Tobacco Control was an important step toward limiting tobacco worldwide, but now we need to make sure all countries ratify this treaty.

While clear solutions are within our reach, change will not be easy. The tobacco industry remains a formidable foe, willing to continue using the ruthless deception displayed so well in the movie “Thank You for Smoking.” Every day, Big Tobacco spends $26.5 million advertising its products and lobbying legislators.

We as citizens may not have the same lobbying clout, but we are fighting the good fight and we can’t give up. Wednesday was the 12th annual National Kick Butts Day organized by the Campaign for Tobacco Free Kids, and advocates across the country mobilized to spread the truth about tobacco and the solutions within our reach. Now it’s time to start kicking butt in Connecticut by making Jessica’s dream for a healthier world a reality.

As I write, billions of your health-care dollars are being wasted, and you probably don’t even know it.

According to the Wall Street Journal, $20 billion are spent each year by doctors and insurance companies trying to sort out each other’s claims. Moreover, according to the McKinsey Global Institute, $66 billion are wasted on pharmaceuticals and about $147 billion are wasted on “operational inefficiencies” in the United States when compared to spending patterns of other developed countries. The total drain on our system each year? About $480 billion — more than double the annual cost of the Iraq war and enough to provide universal health care five times over.

As your money is being wasted, your health isn’t getting much better. The U.S. still ranks below other developed countries in life expectancy, and the infant mortality rate remains shockingly high. Instead, this waste only generates more waste. At the current rates of increase, U.S. health-care expenditures will almost double to $4.1 trillion in 2016.

Now in theory, health spending and some administrative costs aren’t inherently bad. But squandering health-care dollars when 47 million Americans are uninsured and millions more are underinsured is not only morally reprehensible but also fiscally irresponsible.

So what’s the cause of the exorbitant waste? Believe it or not, the problem isn’t government-run programs. Administrative costs for Medicaid and Medicare remain a fraction of those of private insurance. Instead, the fact is that the government isn’t doing enough to regulate our private health system so that it can work efficiently.

Yes, that’s right, the market — that sacred cow of libertarian economists — just isn’t working. While each sector does an amazing job maximizing its own profit, the overall value on the health-care system is being lost. For those of you who made it to the second semester of economics, the phenomenon is called market failure, and it isn’t new.

The market breaks down because we’re competing on all the wrong things. Insurance companies fight over not paying for the sick, and many doctors work to maximize the number of reimbursable procedures rather than the health of the patients themselves. We forget prevention and primary care, and so we are forced to spend billions of dollars in the emergency room instead.

What’s the solution? Single-payer health care, in which the government pays for but does not provide medical care, is certainly an attractive option, but it isn’t the only alternative. At the very least, government needs to step up to correct market failures and allow the health industry to compete over what really matters — our health. Some important first steps include paying doctors for performance rather than procedures, eliminating perverse incentives in the insurance market, and simply having the courage to make investments upfront in prevention and primary care that will reduce costs later.

These reforms aren’t some scary specter of “socialized medicine.” It’s capitalism at its best — getting what you paid for and helping society at the same time. Capitalism only works, however, when demand meets supply. For years, interest-group, supply-side politics has dominated the health scene, offering tax breaks for the powerful but not enough for us. Now it’s time to expose these misplaced priorities and to start putting patients over profits.

As we enter this terrain of patient-centered health care, beware of false rhetoric. Health Savings Accounts and other plans for “consumer-directed health care” that put the burden of change on the individual simply won’t work. We consumers don’t need more choices in the infinitely complex field of health care, we need better choices and better value.

Unfortunately, change isn’t easy. Consumers don’t have the same fancy think tanks and lobbying organizations as other established interests. Moreover, as the system gets worse, the billions of dollars of our money being wasted simply allow these interests to become even more entrenched.

The one power we do have, however, is our democracy. We elect our lawmakers and we can hold them accountable. Last fall, we chose a Democratic majority in Congress and a supermajority of Democrats in Connecticut’s state legislature in part because we wanted real attention to public health.

Unfortunately, in the same way that the health system is wasting money, politicians are wasting time — focusing on petty interests instead of the pressing issues facing millions of Americans. Funds needed to fully reauthorize effective programs like the State Children’s Health Insurance Program remain in limbo, and efforts on universal health care in Connecticut are foundering as legislators can’t make up their minds.

Yale students are now mobilizing with many different coalitions in Connecticut and across the country to make real change. We won’t give up until the fight is over. As wasteful spending and misplaced priorities spiral out of control, we cannot afford to let this opportunity slip away.

On the day after Valentine’s Day, it’s time to talk about sex — the good kind: safe sex.

Perhaps you think Yale is doing pretty well in this area. Indeed, last fall Yale topped a sexual health report by Trojan as the only school to receive a perfect score. Being a leader, however, isn’t easy, and as the flurry of recent news articles around the human papillomavirus vaccine and Plan B emergency contraception suggest, Yale’s sexual health policies lately have been, well, flaccid.

The root of this problem, I think, lies in a phenomenon that you won’t find on the front page of the News: the ever-dwindling bags of condoms in the dorms. Yale says it will provide free condoms in every entryway, but the fact is that these resources aren’t there when you need them. In my floor of Rosenfeld Hall, I haven’t seen any condoms since the beginning of the year, and across the street in TD, the bags for condoms haven’t been filled since December. This trend is apparent in all of the residential colleges, and the bottom line is that something’s not right.

I think that most of us can agree that condoms are good for public health. You’ve been taught the facts in sex-ed class after sex-ed class, but studies show that only one-fourth of sexually active people between the ages of 18 and 24 use condoms. The major reasons cited? Access and cost.

Access and cost are also major obstacles that have been in the news recently around the HPV vaccine and Plan B emergency contraception. The $360 price tag for the HPV vaccine in particular is prohibitively expensive, and without the support of University Health Services, it is unlikely that students will take advantage of this breakthrough in public health.

Yale’s slow response is unfortunate, since all these prevention methods are quite cost-effective. HPV costs the United States approximately $3 billion a year, and the available contraception to prevent one abortion would save the University approximately $400. Moreover, other Ivy League schools have already stepped up to the plate. Dartmouth and Princeton both subsidize the HPV vaccine, and Harvard pays for Plan B over the counter. Yale can afford these programs, and if it wants to maintain its leadership in promoting sexual health, it must step up.

So if cost isn’t really an issue for Yale, why is the University falling behind? In a word, complacency. For example, the problem is not that University Health Services doesn’t want to provide condoms for free to students (sometimes when you go to UHS that’s all you get), but rather that no one is bringing them to the dorms. Volunteer peer health educators are primarily charged with this task, but most fall through the cracks. In a similar fashion, UHS administrators have a responsibility for our health, but with no one looking, it’s easy to stick with the status quo despite new advances with the HPV vaccine or with Plan B contraception.

Don’t get me wrong — peer health educators and even UHS do good work. Our peers are often the easiest to relate to, and the peer health educators do try to make a difference. Yesterday above Commons, for example, some peer health educators were giving out cupcakes and condoms and spreading the word about prevention as part of Sexual Health Awareness Week. Even I learned something new. The only problem was that I was the only one there.

Herein lies the source of this complacency around public health — no one listens until it’s too late. There is no announcement when the bag of condoms runs dry, and Yale doesn’t publicly announce that HPV wouldn’t be funded or that Plan B won’t be paid for. Instead, we wait until months later when someone gets pregnant or contracts an STD. It’s ironic that a couple’s sex incident in the shower would generate more national attention than everyday efforts to save lives, but such is the fate of public health.

Yet even if the University’s complacency is understandable, the result is not acceptable. We as a community must step up and make sexual health a priority, both at Yale and at the state and federal levels. Some say that these issues are matters of personal responsibility, but in reality we are the ones who are at fault for not applying what we know to prevent these problems in the first place.

Fortunately, action to change policy is happening as I write. In the last three days, nearly 1,000 students have signed a petition to encourage Yale to support the HPV vaccine, and more efforts around sexual health are getting under way.

Community action, however, is not enough. As the condom example demonstrates, relying on students alone is not enough. We must institutionalize effective policies and commit the necessary resources so that these efforts can be sustainable. In addition to supporting the HPV vaccine and Plan B, Yale needs to keep us informed about changes to the health plan and assure us that the services we need will be available when we need them. Issues of the day will come and go, but fundamental public health challenges will be with us always.

In my last column, I called you to action. Now it’s time to discuss the details. The theme is global health and the story is how you, dear reader, can save lives today.

It’s no secret that global health presents some of the most striking instances of injustice and inequality in our world. While we are lucky enough to enjoy lives of affluence at Yale, diseases of poverty, such as malaria and TB, continue to kill millions. As Wall Street rakes in record profits from multinational corporations, the globalization of health risks, like tobacco and unhealthy food, is causing a new third-world epidemic of chronic diseases. We may think our strong public health system can keep us immune from the problems of the developing world, but as AIDS and avian flu show, disease knows no boundaries.

I know you’ve heard these stories before, so why is the divide still so large? We feel pity, and we feel guilt, but we do nothing. Although stories of global health continually occupy the front pages, they easily fade into the back of our minds, supplanted by more pressing concerns like a problem set due Friday or plans for weekend fun. Do we not care? Are we bad people? Or have we not been given a chance to take action?

I like to believe the latter. In our era of 24-hour, sensational news, it is easy to feel powerless to help. Just like the never-ending death tolls in Iraq, solutions to our global health problems can seem out of our reach.

So today I write with a new message to wake us from our jaded status quo: We can do something right here, right now. The challenges of global health are huge, but the solutions can be surprisingly simple. Consider for instance the case of malaria, which is the No. 1 killer of children in Africa. For $10, an insecticide-treated bed net can be delivered to effectively provide a child with protection against malaria. We may not be able to save the whole world, but we can help millions avoid preventable illness. We can give millions a chance.

If the solutions are so simple, why haven’t we done anything about it? Well, action doesn’t come without actors. Governments often talk about global health, but the money doesn’t always follow their words. We’d rather spend trillions of dollars on mitigating the damage of civil war in Iraq, rather than on simple public health solutions that transcend partisan lines. Unfortunately, we as citizens remain all too quiet.

Here’s where you come in. We need champions of global health to take action. We need to educate our community about global health, we need to voice our concerns to elected officials, and yes, we need to put our money where our mouth is and support effective programs.

Students in particular are stepping up to this call for social justice in our world. Last month, I got a first-hand understanding of the magnitude of global health activism in New York at a kickoff for the Nothing But Nets campaign, which was organized by the New Haven-based nonprofit Americans for Informed Democracy. Within only one week, hundreds of students from all over our area responded and came to an event organized to send a simple message: Bed nets can save lives. Other organizations such as the NBA and the U.N. Foundation are getting on board, and the Gates Foundation has just announced that it will match every individual’s bed net donation. The momentum building around global health today is simply extraordinary.

Now it’s time to bring this same momentum to Yale. Global Health Week starts this Saturday, and it features a ton of events that everyone can participate in. Throughout the week, we’ll be raising money for Partners in Health, which is doing great work in the field, and we’ll be advocating to improve global health opportunities on campus. Yale has talked much recently about being a global university, and now we as a community need to make sure it keeps its promise.

One week is never enough to combat the challenges of global health, but the greater problem is to do nothing. This week, let’s take the first step to building a better world.

By the third day of shopping period, you may have already chosen your courses for the semester. Maybe you don’t have a clue. Either way, this column is for you. I’m not going to describe which courses are good for your health — although excessive stress certainly doesn’t help — but I am going to explore how the public health perspective can and should guide a Yale education.

So far, I’ve been sharing simple ways that we can improve the health of our community, but so far it has been easy to avoid responsibility. This semester, however, I have a new challenge: Take advantage of your Yale education and become a public health leader.

It’s no secret that you will be a future leader of the world. But before you pat yourself on the back, recognize that this is a scary thought. You may use your power to fight for the good of others, but many will use their privilege merely to perpetuate the status quo and tacitly promote inequality and injustice. The choice is up to you, but the consequences are far-reaching. We all know a few Yale alumni who have not lived up to their potential. The question is, will you?

If no, stop reading. But if you are willing to use your leadership to further social justice, the next question is how. Action is of course essential, but in a world where Yalies only make up 0.00005 percent of the population, we need to go one step further. We need to take advantage of our liberal arts education to acquire the ways of thinking necessary to engage others and enact real change. You won’t find such instructions in any Blue Book, but our generation’s challenges require us to look beyond distributional requirements to find solutions to common problems.

Public health, in particular, underscores the need for liberal arts leadership. Today, we are all too often let down by leaders who fail to address health as an interdisciplinary endeavor. In the United States, poor coordination has led us to spend trillions on an unnecessarily complicated system that continually fails to provide basic health services to millions of Americans. Abroad in developing countries, poor communication between donors, NGOs and local government cripples the health-care infrastructure needed to deliver essential prevention and treatment. Everywhere, barriers between different disciplines are getting in the way of positive change. We, as a community of future leaders, need to find a better way.

The great promise of public health is that by definition it is the essence of interdisciplinary. To truly improve the health of the public, we need not only premeds, but also English majors and economists, sociologists and statisticians. We need everyone, even the skeptics. Public health is about the well-being of all us, and so all of us need to bring our unique perspective to the greater challenge.

What does this have to do with your course schedules that are due next week? Well, now is the time to take the first step. Whether you’re a starry-eyed freshman or a second-semester senior, you have an opportunity to explore public health in a new way. Take a class if you can (see the “Public Health” section of the Blue Book), but if not, at least spend some time getting involved in the numerous activities and talks on campus. The freedom that you have here for such vital learning won’t come so easily in the working world. I may not speak for everyone, but I can say from my own experience that public health was the best decision I ever made.

Fortunately, I have a feeling that I may not be alone. Gauging from the standing-room-only crowd of students who came out at 9 a.m. on Tuesday for Elizabeth Bradley’s new “Health Care in the U.S.” course, it is clear that many students want interdisciplinary study around today’s most pressing challenges, such as health. Yet unfortunately, as I’ve written many times before, Yale’s course offerings in this vital area just don’t meet the demand. While I know that the administration is committed to adding a health studies major in the future, the same barriers continue to delay positive change, even within our bastion of liberal arts.

So, whether you accept it or not, I challenge students and faculty alike this New Year to be the kind of leaders that Yalies should be. The world of public health and of public service more broadly demands it. I will continue to engage you every other week with a new perspective from public health, but it is up to all of us as a community to take action.