PORTLAND, Ore. — How do the structures and conditions of our society affect our health? That's a question panelists will be exploring at an event on Friday hosted by the Oregon Health Forum.

Rebecca Ramsay, a panelist and executive director of CareOregon, said structural factors, such as income, education level and race determine health outcomes. Then there are factors with closer ties to health, such as stable housing, access to nutritional foods, and stress.

Ramsay offered an example of how a child's lack of access to care affects their lifelong health. She said cavities are the single biggest factor in determining if a child will attend kindergarten. Children who don't attend kindergarten are less likely to graduate from high school, and people who don't graduate from high school on average have shorter life expectancy.

"So you can see how all of these factors are interwoven and create a vicious cycle where, really, the experience of living in poverty becomes one of the single most critical social determinants of health factors,” Ramsay said.

The forum starts at 7 a.m. at the Multnomah Athletic Club in Portland. It will feature panelists from other medical establishments, such as Oregon Health and Science University and Northwest Permanente.

Ramsay said the more risk factors a person experiences - such as food insecurity, domestic violence or institutional racism - the more likely their health will be negatively affected. Many of these are outside of an individual's control. She said it's important for people to understand this, and also to understand that health care shouldn't be about blaming someone for their choices.

"Certainly health behaviors and choice play a part - an important part - in health outcomes,” she said. “But that choice becomes very different when you are dealing with having very little money to spend on, for instance, eating healthy."

Ramsay said stress plays a critical role in a person’s health. For that reason, CareOregon supports programs that help families with parenting support to prevent toxic stress in childhood. CareOregon also supports prenatal nutrition programs and family-planning programs to prevent teen pregnancies - a major factor in determining whether someone will graduate from high school.


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An Indiana licensing board has fined a local physician $3,000 and handed her a letter of reprimand after she went public about a 10-year-old Ohio patient forced to travel across state lines for an abortion.

Indiana Attorney General Todd Rokita brought the case against obstetrician/gynecologist Dr. Caitlin Bernard, for comments she made last July to the Indianapolis Star about a young rape victim who could not legally receive an abortion in Ohio because she was just over six weeks pregnant.

Bernard testified she did not feel she would have ever been brought before the board - where she risked losing her license - if Rokita had not chosen to make the case a political stunt.

"I feel an obligation as a physician to share information that is relevant to public health," said Bernard, "as well as potentially in light of certain legislation, ensuring that it is clear that those are contrary to the best interest of my patients."

The AG's office had argued Bernard made the decision to speak about her patient to the largest newspaper in Indiana, which resulted in national publicity for the case.

Indiana University Health, where Bernard works, issued a statement after the decision maintaining its findings that Bernard did properly follow privacy laws.

After the story broke, Rokita appeared on Fox News to discuss it. Other Republican leaders, including Ohio U.S. Rep. Jim Jordan - R-Urbana - suggested Bernard fabricated the story.

Bernard acknowledged that politics made the case more challenging.

"Certainly, there was a lot of media frenzy," said Bernard. "I was receiving significant harassment, particularly after Fox News picked up on the story and began featuring the story in their news segments. I was quite surprised by all of the attention."

Bernard told the licensing board she was surprised that people think young girls are not, unfortunately, frequently raped and become pregnant.




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As Lyme disease Awareness Month draws to a close, levels of some tick-borne illnesses in Missouri are on the rise.

While Lyme infections in Missouri are not as dramatic as they are in northeastern states, officials said there is still cause for concern. Ticks cause a higher number of human diseases than any other insect in the U.S.

The most common tick related diseases in Missouri are Rocky Mountain spotted fever, ehrlichiosis, tularemia, and Lyme, along with newer viruses such as Heartland and Bourbon. Studies show the frequency of infections are increasing.

Dr. Ram Raghavan, associate professor of veterinary pathobiology at the University of Missouri Veterinary Medical School, said there are several reasons why.

"Some of these suburban areas are built around wooded backyards, and people are interacting with the wild more than they used to be in the past," Raghavan explained. "We are also getting very clever and very accurate in the way we detect diseases, there is increased awareness, not only among practitioners, but also patients."

He pointed out climate change is also making winters warmer and extending tick season. When outdoors experts recommend hikers stay in the center of trails and avoid tall grass and brush. Recommendations also include wearing clothing treated with permethrin or insect repellent containing at least 20% DEET, to check clothing for ticks, showering after being outdoors, then conducting a thorough tick check.

Raghavan noted in addition to the many bacterial pathogens transmitted by ticks, there are also threats from emerging viruses.

"Recently, in the past 10 years or so, a couple of new tick-borne viruses emerged in our area here in the central Midwest," Raghavan outlined. "One of them is called Heartland virus, and another one is Bourbon virus. Heartland and Bourbon viruses can actually kill somebody and there have been a few fatalities that have occurred over the years."

The Missouri Department of Health reports the majority of Heartland virus patients required hospitalization to recover. Bourbon virus is named after Bourbon County, Kansas, where the first U.S. incidence of the disease occurred.

A relatively new condition associated with tick-borne illness is Alpha-Gal Syndrome, when people become allergic to red meat. Raghavan said it is transmitted by the most common tick in the state.

"Meat allergy is a significant problem, and it is transmitted by the tick called the Lone Star tick, which is actually the most abundant tick in our region," Raghavan stressed. "Chances are, if someone is ever going to see a tick on them, it's most likely going to be a Lone Star tick. So we need to be watching out for that."

Ticks cannot fly or jump, nor do they drop from trees. They stay relatively close to the ground where they can access soil moisture which they need to stay alive. After rain, the wet conditions and higher humidity will bring ticks out in greater numbers.


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Extreme heat kills about 700 people in the United States each year, but a new toolkit and weather alerts can protect folks in Texas and beyond.

According to an analysis by Climate Central, the annual number of risky heat days has increased in 232 U.S. locations since 1970.

Saqi Maleque Cho, president of the health and development nonprofit Americares, said the new Heat.gov pilot project will help frontline clinics and the patients they serve better prepare for and respond to climate shocks.

"For example, our hurricane resources remind patients to refill their medications before a major storm," she said. "For diabetic patients who depend on insulin, we remind them to keep icepacks and a cooler in the event of a power outage."

From 1970 to 2022, Reno, Nevada, reported the highest number of what Climate Central called "minimum-mortality temperature" days. However, three Texas cities - Austin, Houston and McAllen - were in the top ten for hottest temps.

The toolkit is available at Americares.org.

Kimberlyn Clarkson, chief advancement officer at Texas' San Jose Clinic, said doctors already are seeing health impacts to patients from high heat, including life-threatening dehydration. Those are often people, she said, who work in the agribusiness industry or construction.

"They don't have the option of not going in when it's a 99-degree day, or not reporting for work if there's some sort of inclement weather," she said. "They need the work. They don't have PTO; if they don't go to work, they don't earn income."

To create the Climate Resilience for Frontline Clinics Toolkit, said Caleb Dresser, a physician and director of Harvard University's climate program, a needs assessment was conducted of 450 physicians and clinicians to learn what would help them better respond to their patients affected by heatwaves, hurricanes, floods or wildfires.

"As we look both short-term, medium-term and long-term at what climate change is," he said, "it means greater exposure to climate-responsive hazards for a whole lot of people, all over the country."


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