Health beyond the headlines
Public Health Bracketology

March Madness 2014

the2x2project's public health march madness tournament

Published on March 31, 2014

Every March, the nation’s greatest college basketball teams duke it out (sorry to Duke fans for this year’s early loss) for a chance at national supremacy. Heralded as one of the greatest sporting events in the U.S., much of the hype is generated by people filling out their personal brackets, featuring their best predictions for which teams will make it to the Final Four, and eventually who will take the much coveted national title.

The2x2project decided to join the fray and launch our own March Madness tournament, pitting 16 of the most significant public health issues against each other. With each round, we invite you to vote based on which issue you think is the most pressing or deserves the most attention. The winner of the final matchup will be decided the same day as the final game of the NCAA Tournament, on Monday April 7th.

To help make your picks, the CHEFs have provided a breakdown of each of 16 teams participating in the 2x2MarchMadness Tournament, as well as some commentary on the regions in which they have been placed.

Voting for which teams will advance to the Elite Eight can be done here until Wednesday, April 2:

https://www.surveymonkey.com/s/SXMCRTN

Good luck to all and let the games begin!

Infectious Disease Region

The U.S. has come a long way in combating infectious diseases since the early 20th century, and in fact, seven out of every ten deaths among Americans each year are from chronic diseases. But there are still a few prominent infectious disease issues on today’s health agenda, from polio to antibiotic-resistant bacteria to HPV, and making a big surge as the top seed in the region in this year, the public health threat known as Jenny McCarthy. It will be interesting to see if traditional powerhouses will hold their early season form throughout the rounds or if Jenny’s misguided advice will see her grab the region’s Final Four spot in 2014.

The Teams

#1 Jenny McCarthy

Jenny McCarthy has been all over the news publicly supporting the anti-vaccine movement, claiming that her own son’s autism was caused by vaccines. Earlier this year, we posted about Jenny McCarthy’s position as a host on the The View, calling into question her scientific credentials and moreover, her passion in spreading misinformation that vaccines cause autism. McCarthy’s access to a platform that reaches millions with her misleading views is worrisome, and influences parents’ skepticism toward the conclusive proof that vaccines do not cause autism. This former playmate is not only dangerous, but uninformed, and has put herself in a position to go far in this year’s tournament.

#2 Antibiotic Resistant Bacteria

While U.S. rates of tuberculosis (TB) have declined consistently since 1993, the global picture is not as promising: today, TB is the second leading cause of death from a single infectious disease in the world. Perhaps more alarming, of the eight million new TB infections every year, about 500,000 are resistant to multiple drugs. The Centers for Disease Control and Protection (CDC) reported that more than two million people a year become infected with some form of antibiotic resistant bacteria which continues to threaten our ability to treat infectious diseases as well as the ability to use antibiotics in combination treatment for patients suffering from other conditions. As the No. 2 seed, antibiotic resistant bacteria’s relentless defense will prove difficult for other teams to handle.

#3 Human Papillomavirus (HPV)

The human papillomavirus, better known as HPV, is the most common sexually transmitted infection in the world. There is a need to accelerate the acceptance of HPV vaccination in American adolescents, but the vaccine has been the subject of controversy for nearly a decade. The CDC estimates that 15,000 HPV-associated cancers can be prevented by vaccines each year in women, in addition to 7,000 in men. While there have been anecdotal stories of severe adverse events resulting from the vaccine, current evidence supports its five-year efficacy in both two and four doses. The question is, will HPV be talked about past the Sweet Sixteen in 2014?

#4 Polio Eradication in India

Don’t let the No. 4-seed underestimate the impact of polio eradication in advancing through the tournament. Last month, the World Health Organization certified India as a polio-free nation. India, one of the most populous countries in the world, was once a major epicenter for polio cases, accounting for half of all the cases reported globally in 2009. Some criticize the momentous cost that went into eradicating this disease, wondering whether resources may have been diverted from more pressing public health needs. Will this global health achievement stack up well against the higher-seeded infectious diseases it will face in this region?

Government B.S. Region

Public health depends on effective government. Unfortunately, political failures—whether through harmful policies, gridlock or pure incompetence—have profound adverse effects on the public’s well-being. This exciting and highly competitive region has been made possible by copious quantities of government B.S. Beyond furnishing ample material for late-night comedy shows, these U.S. government antics threaten the health and welfare of all Americans, particularly our most vulnerable citizens. It’s going to be hard to pick a winner, but I predict that Federal Funding Fiascos will do well, benefiting from the passion and frustration it inspires in its devoted fandom.

The Teams

#1 Affordable Care Act Enrollment

The ACA has the potential to transform the American healthcare landscape and drastically reduce the number of Americans without health insurance—if people manage to enroll in insurance plans, that is. The March 31 deadline for the ACA’s first open enrollment period highlights the uneven and complex roll-out of this new law. The extent to which the ACA ultimately succeeds—or fails—in improving Americans’ health and well-being will have far-reaching implications for public health, making it the top seed and current favorite in this region.

#2 Federal Funding Fiascos (National Institutes of Health & Government Shutdown)

Our representatives played politics with American lives in October 2013, when the third-longest government shutdown in U.S. history placed an enormous range of key public health programs in limbo. Meanwhile, devastating NIH funding cuts threaten future public health research and advances. Players for this team continuously manage to set new personal records for obstruction and excess time-outs. If the team could get its act together and cease to embarrass itself in front of audiences nationwide, that would be a major public health victory.

#3 Incarceration

The U.S. has the highest incarceration rate in the world, with black men imprisoned and jailed at nearly six times the rate of white men. This “new Jim Crow” perpetuates racial disparities while also hurting public health. Stress, trauma, unhealthy prison conditions, and the disruption of community/social ties all have harmful health effects. Meanwhile, out on the street, stop-and-frisk policies also have hazardous emotional and physical impacts. Successfully reforming our criminal justice policy would be a slam dunk for public health.

#4 Farm Bill and Food Stamps

Bookies often overlook this region’s underdog because it primarily affects disadvantaged Americans who struggle to put food on the table. Despite recruiting some promising new players, this team has an extensive and often disappointing record. Most recently, negotiations around the latest farm bill led to billions of dollars cut from the Supplemental Nutrition Assistance Program or SNAP program, better known as food stamps. This has left some of our most vulnerable neighbors, including pregnant women and children, even less certain about where their next meal will come from. With over 50 million Americans who will live in hunger at some point in their lives, we can only hope this team will put an end to the losing streak that has led up to this tournament.

Drug Region

Drugs are in fact good, but only when there is money to be made (and depending on where that money goes). Opioids procured at a pharmacy are acceptable, but a scourge if found on the street. Marijuana can be used for recreational purposes, but only if a 95 percent excise tax is paid.

Drugs, either prescribed for cholesterol or available to purchase “by the barrel,” have long held a distinct place within our society. Individually, people may need them and we may need them or become dependent or addicted to them. At a population level, however, the practice and policies that guideline how we see and use them can have a lasting public health impact. The most influential impact, you ask? You decide.

The Teams

#1 E-cigarettes

Already trending among teens, will it be a public health scourge or a harm reducer reality? There’s no denying its growth, and left unchecked and unregulated, e-cigarettes might totally eclipse traditional cigarettes—for better or for worse. This No. 1 seed is a force to be reckoned with and is a strong contender for this year’s title.

#2 Marijuana

The public health impact of marijuana reform remains hazy. While promising medical research is on the horizon, some states appear more preoccupied with profits than patients. Will this No. 2 seed find a way to blaze its way to the finals?

#3 Prescription Opioids

There has been much ado lately about the fix formerly known as Zohydro, but the real “abuse deterrence” may be the non-steroidal anti-inflammatory drugs (NSAIDs) that opioids were traditionally cut with. Meanwhile, treatment of non-malignant chronic pain continues to rise. Have docs written a prescription for success or will opiods let previous scandals hinder their performance in the tournament?

#4 Statins

One in three Americans will die of cardiovascular disease, and statins work by reducing high blood cholesterol, one of the main risk factors. New guidelines, however, could double the number of patients being treated with statins. With a few late season overtime wins, statins look poised to handle the pressure of being on the national stage.

Youth Health Region

In the youth health region, the teams in competition are childhood trauma, sports-related concussions, gun violence, and childhood obesity—all public health issues facing kids today. Let’s have a look at some of the key players and statistics for each team, so you can make your predictions.

The Teams

#1 Childhood Obesity

Top seed in the region is childhood obesity. For one thing, this team is big: 17 percent of kids are obese and 25 percent are overweight. And obesity is a proven offensive powerhouse, increasing chances of diabetes, heart disease, cancer, and more. Financially, the costs of the franchise are estimated to be a whopping $147 billion. That’s going to be a lot for any opponent to take on.

#2 Concussions

Brain injuries among pro athletes have seen a lot of court time recently.  Many of the players on this team are kids and teens who participate in recreational sports. Children 18 and under suffer 173,285 concussions related to sports and recreational activities each year that have been linked to brain disorders. That’s bad news not only for the current season, but later in the game, and possibly for the rest of their lives. Will depression, dementia, or Alzheimer’s disease score against them in the end?

#3 Gun Violence

The fallout from access to guns resulting in gun violence impacts young people most severely. Among 15 to 24-year olds, the rate of firearm homicide in the U.S. is more than 42 times that of other high-income countries. Mass shootings are an attention-getting move that reveals just how scary this threat can be.

#4 Childhood Trauma

Childhood trauma, including experiencing neglect, abuse, assault, and witnessing serious violence affects over 15 million kids each year. The effects of such horrors are numerous and can sadly last beyond a lifetime. Many of the perpetrators of violence against children were once victims themselves, and the cycle goes on—not the kind of dynasty to be celebrated, but avoided at all costs.

Edited by Elaine Meyer

 

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The views and opinions expressed on this website are solely those of the authors and do not represent those of the Department of Epidemiology, the Mailman School of Public Health, or Columbia University.