What every baby needs... a (not) shopping list

A friend of mine is due any second now with her second baby, and it brings me back to those pre-first-baby days of worry... Do we have enough? Do we have the right things? What are the right things??? Everywhere we turned, the list of what was necessary, desirable or inevitable kept growing. "Do you have a swing? You can't get by without a swing!" "You can't go for a walk if you don't have the right stroller..." "If you're going to breastfeed, then you'll need a pump." It was crazy! And the times only got more so in the intervening years; the stroller I see most in my middle-class neighborhood is the one I first saw in a photograph of a celebrity (and which costs nearly $1000!) So, for a little sanity, here is a list of what is really, really necessary:

1. One fetus ready to be birthed

2. One mother ready to birth (biologically ready; rarely do we ever feel psychologically ready)

3. A supportive community

That's it. Really. Ok, once the baby is born, a few more things are useful, but not nearly as many of those as one could be led to believe!

What not to buy (at least not right away):

An online checklist (pretty typical of its kind) from The New Parents' Guide suggests no less than 42 items (many of which are for several of its kind), which if purchased new would easily cost the new family over $1000 for the big-ticket items (bought modestly based on the website's recommendations) before getting into clothes, wash cloths, diapers, bottles, creams, bras, etc., etc., etc.

So, let's pare down this list a bit. The first item on everyone's list is an infant car seat, preferably one that connects into a whole travel system. If the baby will be going in a car, yes, an infant car seat is the only safe place for her. Of course, we are assuming that you will be transporting your baby in a car. If you birth at home, baby doesn't need to go anywhere any time soon. Once, you are ready to go out into the world with your baby, there are other ways to carry that little one.

In place of the car seat/stroller travel system (which is far less expensive than the fancy infant strollers and jogging strollers, but still cost a couple hundred), may I suggest wearing your baby? At least when walking around (not in a car ever), a wrap or baby pack is far more relaxing for baby (and therefore for the parent in question). In fact, a good one will cost you less than a comparable stroller ($50 for a great versatile one with good instructions, versus $300 easily for a stroller that can accommodate an infant at one time and a toddler later).

Cribs are another big expense; typically $200 for a low-end new crib and another $100 for the mattress, plus covers, sheets, bumpers. Plus, many people get both a crib and a bassinet or pack-n-play (another $70-200) for the new infant. I'm going to propose a crazy idea, one that has been used for millennia (successfully) and is supported by good solid research: co-sleeping. Bed-sharing can be easier, more gentle and safe for all involved. When looking at ways to make your adult bed safe for your infant, definitely read the guidelines. In addition to what the experts will tell you, I found the least expensive route was to move our mattress to the floor (away from the walls). This part of our lives didn't last all that long in hindsight until the baby was ready to move in to her sister's room and a big-girl bed (although my partner would not have believed that at the time). Co-sleeping became a lesson in parenting in general: they grow and change too fast to rush it!

Diapering is another big expense, or can be. From personal experience, I can honestly say that cloth diapers (laundered at home) are not really any harder than disposable. (Parenting is tough; diapering is inconsequential compared to that!) It is also a lot less expensive (a starter set of diapers can cost up to $75, which might get you through a month of disposable diapering.)

There is also the question of whether diapers are necessary at all, when compared to a practice commonly called elimination communication. A friend once told me that "it's not natural" to keep a baby sitting in its own waste all day (not the same waste, of course). I can not say if it is easy or challenging from personal experience as I heard of it after my youngest had been diaper free for several years. If given another chance, I think I would try it though. With dropping the diaper, we can also lose the diaper pail and diaper rash ointments. Not a bad deal in my mind.

The last item on my "needs to be questioned" list is the breast pump. I am so very for breastfeeding (cost and convenience and confidence...), and pumped for both my babies when they were babies and I was away in an office. It is not the usefulness of a breast pump under the circumstances for which it was designed that I question, but it arriving at a baby shower. As Kathy Abbott, IBCLC, (the Curious Lactivist) said at a basics of breastfeeding workshop given by the Nursing Mothers' Council, giving a pregnant woman a breast pump gives new mothers the message "you can't breastfeed without this machine," not a helpful message at all. A pump, if needed, should be purchased once you know what you need it for; breastfeeding only requires a baby and the mother.

What you really will need:

This all takes me to the one item on my list that the checklists don't include (maybe because it can't be purchased): community. The mother's partner (you know, the snuggly one on the other side of the bed) is a good place to start. There are a million ways for the partner to be involved with the mom, with the baby, with parenting, from the beginning. This can relieve the stresses of adapting to parenthood on mom (at least there's someone else in this with you!), and keep everyone connected.

Community also extends beyond this tiny family unity, though. In all the advice to prevent or decrease the stresses of having a new baby, community comes up again and again. This is both practical (not trying to do it all, have a list of things visitors/family/friends can do for you), and emotional (having people who listen and understand.) New parents should take the time to recognize that this is a big transition, all new parents go through it (although differently), you are not alone! Surround yourself with people who are supportive and helpful. Other new parents can be found in the baby/kid section of the local library and at the local (toddler-friendly) playground during school mornings. Go for walks and say "hi" to people. Offer the kind of friendship you are looking for; it can inspire others to return the favor. It all comes back around to you in time.

In addition to this peer community, it is also good to know where you can get sound advice if you need it. Finding a pediatrician that is respectful of your parenting choices is well worth the effort. There are also organizations and other resources to help you figure out the logistics of your choices. For example, if you run into challenges with getting breastfeeding started, for example, there are volunteer organizations (a few) with well trained volunteers, and professionals that can help.

So, make sure you've got good people around you, and then enjoy the fleeting days of babyhood. At least you know that most of the stuff isn't worth worrying about.

In defense of Halloween

Halloween, by other names, predates Christianity, marking the end of summer and extended days and the beginning of the cooler time of year. Most folklorists connect it with Samhain of Celtic tradition, with similar festivals to mark this transition around Europe. In the U.S., most people consider it a secular, cultural holiday. From our childhood, it is marked by costumes, night-time roaming, and candy -- what's not to love?

As a night owl with a closeted penchant for drama and a not-so-closeted addiction to candy, Halloween was easily my favorite time of year as a kid. When I remember how Halloween was celebrated in my neighborhood, I remember all us kids spending hours, usually days or weeks, making or putting together costumes. There was the year I was a lollipop, with tan pants and a hot-pink-tissue-covered cardboard-and-hula-hoops sucker end (thanks, Mom). There was the year my sister was a robot (more cardboard, this time with tinfoil). And, of course, the old stand-by, "Gypsy" with lots of jewelry and scarves. The kids on the street, with whom we played throughout the year, would end up as one big knot of riotous, giggling candy-beggars. From house to house, if the lights were on and the decorations up, we rang or knocked. We met many a neighbor, young and old, recently moved into the neighborhood and always been there. At the end of the evening, we'd all get corralled into our respective homes, gorged on chocolate, sugar, and artificial dyes. Again, I ask what is not to love?

Fast-forward through the years of not trick-or-treating, to today. As a mother of school-aged kids, one of whom has the added love of all things Halloweenish by sharing her birthday with the month of the holiday, I am amazed at Halloween's image in this day and age. Apparently, this cherished tradition has become an excuse to scare the pants off the parents, not with zombie movies (my personal weakness) or ghost stories, but with check-for-sex-offenders and don't-meet-strangers advice. According to Halloween Safety Guide, parents' worries get to start at checking for local sex offenders ("just a fact of life now"), move on to every possible way to avoid your child being snatched off the roads ("In most cities it is not safe to let kids walk the streets by themselves."), dally through fire-proofing your kids' costumes (I wasn't planning on lighting it on fire, at least not with them in it), checking props for the potential to impale if the child should fall on it (really?), and (after more about not getting snatched) ends with crossing the street safely. To add to this list, other sources suggest checking your kids' candy to for loose wrappers, in case they were tampered with.

The instructions for kids parallel those for adults, including such warming ideas as "Never go to a stranger's house, or even ring the door bell, unless your parents are with you and say it is ok..." and my personal favorite: "If you can drive and are taking a bunch of friends to a party, make sure that you have enough gas to get there. You don't want to run out on a dark street, all alone, like a bad horror movie!" (What happened to those friends you were driving?? And, when did Halloween and its sequels offer us guidance to real life?)

Ok, in all seriousness, no one wants their kids to get snatched, including me. However, what are the odds, really, of being snatched? In 2009, the number of people under the age of 18 that were reported missing and determined to be missing "involuntarily" was 5,901 out of and estimated 74 million people under the age of 18. This gives us 8 children per 100,00 children, or 0.008 % chance. This includes children who were taken by a family member or other acquaintance, runaways and throwaways. In fact, kidnappings by strangers are so rare, I've started explaining to parents who ask, "but aren't you afraid," that if I wanted to decrease their odds of being kidnapped, I'd have to teach my children to fear only family and friends; strangers would be the safety. The rates of kidnappings, all together and by type of kidnapping, have NOT been getting bigger since we were kids. Currently, we are about the rate of abductions as we had in the 70s (lower than when I was running around in the 80s.) Despite all the voices telling us that "in these times" or "these days" or "no longer" safe, life for kids is safer than it was back in our day!

Alright, we are clear that the kiddos are not in danger from getting snatched. Now, what about tampered candy? We all grew up on the stories of razor blades in apples and poisoned candy; they must be true, right? What if I told you that they were nothing more than urban legends? Yep. There have been no confirmed cases of poisoned Halloween candy from strangers, no cases of any kind of threat to kids from the treats received from strangers. As far back as the researchers have been looking (into the 1950s), not a one. The kids are still safe.

While I haven't seen any statistics on the other scenarios (impaling oneself on props or running out of gas on a lonely road and discovering oneself in a horror movie), the straws are getting thinner. And, I'm still not planning on lighting my kid on fire. Cars are still a danger, and knowing how to cross the street on any day or night will serve kids well; so I can honestly say that that piece of advice is always a good one. A glow stick or reflective tape couldn't hurt, either.

On the other hand, there is a lot to be said for the advantages of the old-school Halloween:

1. Independence! Kids are craving it and will reach for it wherever they can find it; better to make it available in safe and exciting ways, than through acting out. Better to have a walk around the neighborhood by themselves.
2. Community! Yes, getting to know your neighbors is good for your kids and you, and your neighbors. Neighbors that are connected are stronger and safer.

So, I say, for your health, for your kids' safety, for your community and neighborhood, and just for the fun of it, go out and trick or treat!!

Unplugging, getting moving and getting cooking

This is in response to Anastacia Marx de Salcedo's article with Public Radio Kitchen, and one reader's request for a How-To piece (and with Anastacia's permission.)

We live in an All-Or-Nothing atmosphere, and the discussion about healthy weight and weight-related choices is just as divisive. On the one hand, we have people who see the sky-rocketing rates of obesity and want everyone to lose weight; on the other, we have people who see the sky-rocketing rates of eating disorders and (non-clinical) disordered eating behaviors and want everyone to embrace their bodies unconditionally. Both sides are right, of course, and therefore both are also wrong. The small amount of research on integrated messages, ones that combine both eating disorder prevention and obesity prevention, shows serious promise. Integrated messages also are healthy for everyone, and by bridging the two doctrines, provide a united healthy message in place of extremes. Integrated messages include three main parts:

• Unplug: Watch less, and question more of what is watched
• Get moving: Find activities you love and do them
• Get cooking: eating real food in reasonable portions

Unplugging

Americans watch far more TV and related media than in previous generations, for more hours per week, and it has an impact. First, media consumption (TV and magazines are among the worst for this, but it is everywhere) is related to body-type dysphoria (hating your shape). The actors and models all represent an impossible "ideal." In fact in one small study in England, comparing body attitudes and healthy behaviors among women who could see, had lost their sight, or had never been able to see, the women who had never been able to see were the healthiest. The authors of the study attributed this to their never having seen this "ideal" and therefore never questioning whether their healthy bodies were anything less than adequate. Children's media is particularly challenging for this, as the out-sized child is disproportionately the meany or dolt (as with the dark-skinned or unattractive child). Really.

Second, TV, especially children's, is full of ads for junk food and passive activities. Studies have shown what any parent watching has noticed: kid's TV ads are almost never for healthy foods and all about sugar-bomb cereals (a la Calvin and Hobbes), convenience food-like items, sugar drinks... and on and on. They have also shown that kids that watch these ads ask for these things more, and kids that ask for them more get them more. (This is not a critique of parenting here; we all make compromises to respect our kids' integrity and decrease family strife. This is just looking at the impact of those ads: they work.)

The same process happens with the activities. The ads are not for playing kick-the-can or tag; they are for junk-food of the mind and body: more TV shows and movies, video and computer games, and indoor (branded-character-based) games. Watching TV itself decreases activity-levels, sucks away hours and hours each week that could be spent doing anything else. Then, it convinces you to watch more and play (sitting down) games that tie back into the shows.

SO, what can we do???

1. To start, turn it off. Many households just leave it on between shows, drawing you (and especially kids) back into its clutches. Just turn it on for the shows you intentionally want to watch; make an intentional choice about which those are. This can also help you find out how much you watch. (It is probably more than you realize.)

2. You can try literally unplugging the TV. Just plug it in for the one or two things you really want to watch, then unplug it again without changing channels to see what else is on. The extra act of plugging it in makes it a conscious act, instead of an unconscious habit. When TVs first came out, one reviewer's comment was that they were nice, but "Americans don't have enough time" for them. However they have become a habit that can be hard to break.

3. Be ready for the withdrawal. If you are going to decrease how much you and/or your family watches, you should know that there is withdrawal. While we are watching TV, our brains are putting out hormones that keep us feeling mellow and content. When the TV first turns off, we get agitated and uncomfortable. (This is part of why watching TV before bedtime is problematic for people who suffer from sleep problems.) It goes away. The physical withdrawal goes away within a half hour. The psychological withdrawal, having to think of something to do instead, can last a little longer, but is worth overcoming for its own sake!

4. Watch what they are watching. Talk about it. A major point in the integrated messages is media literacy. It is also a huge learning area that is both critical in this age of media overload, and that is under addressed in the schools (already focused on raising test scores.) Media literacy starts with questions. Question the assumptions that the show makes; talk about stereotypes; ask if there are other solutions to the story's drama; talk about who makes the show and why; ask how the story makes your child feel... the dialogue can be endless, even over Bay Watch.

Getting Moving

We are a country of sitters. We sit at work (more office jobs, less active jobs, in an information age.) We sit at school (lunch recess and gym class being cut beyond recognition). We sit at home (in front of the TV or computer). We sit when we go from place to place (passive commuting for both kids and adults)... We are expert sitters, but not much else!

Getting moving starts with the fun and practical, and should stay there. Joggers jogging to jog is not the idea here. Kids running to play tag or for the joy of feeling the wind in their faces is more what we're talking about.

1. Do it together! Girls and boys whose parents engage in physical activity with them stay active. Whether you are swimming, biking, throwing a ball around, playing tag, or being the "monster" at the playground, YOU doing it makes a world of difference.

2. Commute actively. Getting a ride to school is not so helpful. Walking and biking to school encourage independence and activity over passivity. If walking together, spend the time listening to your child or notice the weather and seasons passing together. Take public transit and walk instead of using your car. If the car is required, try parking at the far end and walking farther to the door.

3. Get outside. Our bodies and minds respond to the cleaner air of the great outdoors (yes, even in the city the outside air is healthier than the air inside our homes), to the wider spaces and freedom from the electronic devices (back to unplugging). People who spend time outside, enjoying being outside, are healthier and more content than those who only scurry from home to car to place to car to home. You can explore your yard, neighborhood, local flora and fauna, or go farther away for new vistas. Camp in your backyard, take a walk around and about, splash in the puddles, climb trees, make mudpies... the options are endless!

4. Keep it fun! This is for parent-child bonding. This is for encouraging your child to enjoy being active. This is not for you to win, and your child does not need to learn how to be a great ball player before you are done. If kids enjoy playing a sport, they will get better at it just by doing it. The occasional tidbit of information or frustration maintenance is fine; but don't push it. An over-eager parent can just as easily squash a budding interest as one who is completely unengaged.

Getting Cooking

In this country, our portions have become mammoth, and our convenience food-like consumables have become standard. From every direction, nearly every year, it seems there is some new truism about food, most of which contradict each other. In thinking about healthy food, I like Michael Pollan's advice in In Defense of Food, "Eat food. Not too much. Mostly plants." To this I would only add, "Many colors," as the diversity of our foods expands the nutrients we get from them. Restaurant, take-out and prepackaged foods contain insane additives and come in unrealistic portion sizes. Just as one example, a bagel should be about 3 inches in diameter and only contain flour, yeast, salt and water (a touch of sugar and oil optional). Store bought bagels have grown in the last few decades to 6 inches in diameter or more, and include preservatives and other (inexplicable) chemicals.

(If the commercial world's portion sizes have come home, simply eating off of smaller plates quietly retrains the eye to expect less and the body to eat slower. Just the conscious act of refilling the plate slows us down and helps to prevent eating until we feel sick.)

Now the question becomes, how to get kids eating home-cooked food? Your toddler wants to live off of one food for what appears to be the rest of her life? Your teenager considers anything not prepackaged as poisonous? Research suggests that the more involved kids are in a meal the more likely they are to eat it. Get them cooking with you, or even instead of you.

1. Choices, real honest choices. Stock the home with healthy options: fresh produce and whole grains. Then, let your toddler pick her snacks, or your teenager plan a dish or even a whole meal for the family. Kids are on a road to independence, and this is one way to encourage it that you can feel good about.

2. Offer new options, and keep offering them. Diversity of foods is great and important, but so is patience. Research shows that kids need multiple exposures to the same foods before they really feel comfortable with them. In the wild, where food plants frequently have poisonous look-alikes, the proper way to test a new food is remarkably similar to the toddler's process: put it in your mouth (don't chew or swallow) and spit it out; if nothing bad happens, put it in and chew on it (but don't swallow) and spit it out; if nothing bad happens, try a tiny portion; if nothing bad happens... So, your picky child is supposed to go through this process; it is what has kept us alive for the countless millennia before supermarkets and drive-through windows.

3. Don't micromanage the process. Cook what you as a family enjoy; model enjoying your green salad or beet soup, and then trust. Kids that are exposed to tasty vegetables, to adults enjoying those vegetables, are going to eat vegetables when they are adults. (When you aren't looking, most likely.) Let them find their favorites.

4. Have fun cooking together! It is a chance to bond and share family traditions and comfort foods, values and happy memories. Just by cooking together, you are making a difference. For example, a chocolate cake cooked at home will still be a cake, but won't have some of the unpronounceable and undesirable additives of a store-bought cake. If you child only wants to spend time cooking the sweets, that is ok. In time he may expand his repertoire into sweet breads, then into soups... (at least that is what happened with my little non-domestic.) There are tons of kid-friendly cookbooks out there. (My kids like Spatulatta.) But, your family's favorites will be more effective than anyone else's cookbook.

So, in the end, the advice is all about making time. Time to spend together, to play together, to cook together. I can hear the whisper (roar?) in reply, "But I don't have time!" I know. I get it. Life is crazy, busy, hectic. Much of this happens instead of (not in addition to) other stuff. Turn off the TV, and instead go play tag outside. Instead of waiting 30-45 minutes for the pizza delivery person, boil whole wheat past and chop up a tasty salad. Or, make your own home-made pizza in only 15-20 minutes extra. Yes, it can slow life down, walking to school or sitting down to a meal... but isn't that a good thing?

PS (There is a lot of research not linked here; if anything interests you, please email me at kdbergman@yahoo.com, and I can send you more information.)

Summer without air conditioning... or a car

This summer has been wonderfully, steamingly, ridiculously (for Boston) hot. I have discovered that Bostonians are (almost to a person) unaccustomed to the usual week or two of hot, humid weather. We are acclimated to air conditioning. Last summer, which had very little over-90 weather, I was surprised with how long a day with no air conditioning can be. I had been conditioned by years of work days in work offices uncomfortably refrigerated, only being in the natural heat of summer during my commutes and (maybe, if I was lucky) for a little at lunch time. The conditioning caught me by surprise, since I had been away from the office for nearly a year at the time. This year, however, with plenty more heat, I was ready. And comfortable. We spent our time in the local free pool, or carpooling with friends to a nearly-local free beach. Which leads to the other change this year: car-free. We lent out car to my sister's family, and have been getting around without since.

So what? you may be asking. Or, What does this have to do with health?

Cars and air conditioning are among the technologies most people can't imagine getting along without, but I would make the claim that for most people, for most of the time, we need to try. These technologies separate us, isolate us. When we drive in and out of our neighborhood, we have no idea who our neighbors are. When we walk up and down our street, to the bus, the store, the post office, we meet people. I've always claimed that having kids and dogs are two of the best ways to meet people. The reason they work is because they force you (if you let them) to walk to the park, go for walks, and stop to meet every new discovery, from an interesting weed growing in the cracks of the sidewalk to the people on your street. These days, people with kids get bigger vehicles (beyond mere cars) and equip them with DVD players and climate control. We can't see the weeds, we can't say "hello," and now we don't even know what we are missing!

Air conditioning also isolates us from our neighbors. The house is closed up, sealed from the sounds and shared air of our neighborhood. We turn inwards. We close ourselves off from each other. And then we acclimate to the climate control. After a few hours of this, step outside, and Ugh! The natural environment feels down right hostile! So we scurry to the car, and crank the AC. Rush in and out of the errand we were running, not pausing in this uncomfortable air, and back into the house before we sweat too much. A few hours quickly turns into days, weeks, and the whole season, protected from summer.

When I was small, we lived in Delaware and summers (which there occur between April and September, inclusively, not just August and maybe July) were spent entirely out of doors. After my family moved to the Boston area, we would go back and visit, especially in August (the height of the heat each year.) My sister and I would run around in the neighborhood with the other kids. One year, my grandparents got AC, and "Go out and play; it's gorgeous out." was replaced with "You can't go outside! It is too hot. It isn't safe." That was the first year we did not know the kids in my grandparents' neighborhood. In a similar vein, in The Divine Secrets of the Ya-Ya Sisterhood the narrator talks about living in the deep South, and how people used to virtually live on their wrap-around porches all summer long. Before AC. Now, the story claims, the same humming desolation hangs over the streets.

So, for comfort we enclose our kids and ourselves in climate control, not meeting anyone. What are the consequences? It is hard to be certain. There is evidence that the activities we engage in indoors (screen time with the computer and TV screens) are being engaged in out of balance with outdoor activities. We sit and don't use our bodies, we don't get sunshine (lack of vitamin D), and we are socially and emotionally isolated. The evidence is not there, but it seems to me that air conditioning and driving are detrimental to our health, physical and emotional, as individuals and as communities.

In contrast to the model above, my kids and I have been out. We have met dozens of people on buses, on the street, at parks and pools and beaches. Our bodies are healthy and strong. We feel connected to the people around us. We feel safer, and are safer in our community because of those connections. And maybe, just maybe, we've cheered someone up, brightening their day, helping them to feel connected, and made them a little healthier. It wasn't easy to get used to at first, but it was well worth it, and a lot of fun by the end!

Be here. Now.

My personal exploration of Buddhism, which kicked off the previous posts, was initiated with a desire for peace and tranquility of mindfullness, being here now. There are so many ways in which this practice, being mindful, improves our personal well-being, our interactions, our communities, and the larger health of our ecosystem, it is hard to begin. So, I will begin with someone else's words. Manitonquat of the Pokonoket Wampanoag (indigenous to southeastern Massachusetts) tells this story in The Children of the Morning Light:

Long ago, there was a time when Grandfather Sun only showed up for a few minutes each day. It began gradually, and so went unnoticed at first. A few minutes less each day, until the people began to get worried. There was not enough time to plant, to hunt, to gather fire wood. The people were bored and restless, sitting by fires in the dark and cold all the time. They asked their divine helper, Maushop, to speak with Grandfather Sun on their behalf.

Maushop made himself a giant, went into the ocean to the east, and waited. The first three times he tried to speak with Grandfather Sun, he could not get in all the words before the sun had set in the west and was gone again. So, he wove a giant fishing net of seaweed and waited again. This time he caught Grandfather Sun, who was surprised. He agreed to listen so that he could get out of the net.

When Maushop explained about the people's concerns, Grandfather Sun was surprised again. He said he had thought the people here did not notice him or care if he came since they had never greeted him, and never said good-bye. The people on the other side of the world had paid more attention to him, so he was spending all of his time with them, as traveling through the silence and being ignored made for lonely work.

Maushop returned to the people and shared Grandfather Sun's words. The people were ashamed. They had not thought the sun had feelings, and asked if they could make it right. Maushop returned and told the sun how the people had felt and that they promised to greet him every morning, smile and wave to him every day, and bid him good-bye every evening. Grandfather Sun felt better about this, and now lingers with us as much as with those on the other side of the world. And the people teach their children to keep the promise.

As I tell this story to my children, I realize that it is in many ways literally true. If we do not notice the sun, the beautiful day we have right now, it is as if it never happened. Many other traditions also teach us to take time and reflect. Judaism, Christianity and Islam, for example, all have weekly days of rest and reflection. However, these are days to reflect on our actions and thoughts of the past, on the meaning of our traditions' teachings. How often are we invited to reflect on the here and now? No judgement, just taking a minute to get to know this moment and place. Thich Nhat Hanh, in You Are Here, also shares with us a daily practice to welcome the day and focus on the here and now:

I begin my day by making an offering of incense while following my breath. I think to myself that this day is a day to live fully, and I make the vow to live each moment of it in a way that is beautiful, solid and free. This only takes me three or four minutes, but it gives me a great deal of pleasure.

What a beautiful practice: acknowledging each morning as a gift from the universe to us. When that day is hard, frustrating or unpleasant, our starting point lowers the stress we experience. My practice is to take a cup of tea out into the postage-stamp yard, barefoot in the grass, and face east. The sun (or clouds) in my face causes me to look up and close my eyes for just a minute. Feet on the earth, face to the sky. I thank the sun for shining and warming, the earth for supporting and giving life, the breeze for cooling and providing change, and the rain for quenching and nourishing. Then I face my work, my children, my day. Those few minutes of connectedness and grounding provide me with more patience and stability in my day. My stress is lower, and my health and well-being higher. Not a bad return on my investment!

When we approach our days from this perspective, being here now, we also approach other people more peacefully, empathetically, connectedly. The research shows us what we intuitively know: people need people. People who are disconnected from others and community have poorer health, more stress, and lower health and life outcomes. Youth who drop out of school feel that they are not connected to any of the adults around them. Elders who are connected to community are healthier and more active. Parents who have meaningful and supportive community around them suffer less from depression and parent better. And, communities where neighbors know each other and are connected to each other are healthier places to live, stronger communities, and safer for everyone.

Instead of connecting, we spend much of our times disconnected from each other, not making eye contact, isolating ourselves. This deepens our chronic health problems as individuals, and as communities. The disconnect comes in the form of racing minds, planning and worrying about the future and past. It comes in the form of interactive and passive technologies that take us away from the here and now. It comes in the form of social norms of not communicating with each other.

To reconnect with others we need to break those social norms. Breaking norms is always challenging; it takes us out of our comfort zone. It is easier to start with just a smile, nod or "hello" to neighbors and strangers as you walk around, commute to work, or do your shopping. Greet the person at the cash register next time you are in the store and you may be surprised at the good it can do you both.

Disconnecting from technologies can be tough. We have so many reasons to feel that we need to get email the minute it arrives, be available by phone every minute of every day, or "connect" with people through the filter of the internet. Try making a change. A colleague of mine used to be completely attached to his Blackberry device, always getting emails and calls. He operated under a constant state of stress as a result. One day he chose to only check email twice a day, to let voice mail get his calls when he was busy. His stress level dropped dramatically. His productivity also improved. He could now concentrate during meetings and conversations. He could really connect with the people on his team and work more effectively together. Not to mention he was much more pleasant to be around.

To stop the racing mind is a bigger challenge. It takes practice to calm a mind that hops from topic to topic or worries an idea to death. The Buddhist practice of meditation is exactly for that purpose: to be here now, and truly see and comprehend this moment, we need to be unclouded by busy-ness; to calm the busy-ness, we need to practice calming our minds. In some Buddhist traditions, meditation is practiced in a special, quiet place at a special time. This can be helpful for many people, and I recommend exploring that option if that works best for you. (Peaceful Piggy by Kerry Lee MacLean is a very easy to follow, family-friendly approach.)

For me, however, I am discovering that I need to connect to the here to calm the mind. I focus on each of my senses to appreciate the moment and connect to where I am. The moment need not be perfect to be embraced. To change whatever is not working, I have to first know -- really know -- whatever it is and why. I have to embrace what is so that I can understand it well enough to change it. When I start to hear the thought, "This isn't how it is supposed to be..." I know that I am disconnecting from reality, and it is time to reconnect.

Whatever your practice, whatever way works for you, remember: Here is where you are. This moment is the only one of its kind and is precious. Everyone, even the sun, needs and deserves to be heard and connected with. With these lessons, we can make the world a better place.

Dukkah -- Dis-ease and health

This is the third post in the series connecting aspects of Buddhism and public health. In the first two, I explored two of the dharma seals: impermanence and interconnectedness (although the second is frequently extrapolated to its most challenging application: non-self.) The third dharma seal is usually considered to be dukkah. Dukkah is frequently translated as suffering, but in a very broad sense. Another translation that may be more accurate is dis-ease, dis-comfort. The Dalai Lama posted on Facebook earlier this week this comment on dukkah:

"Every type of happiness and suffering can be divided into 2 main categories: mental and physical. Of the two, it is the mind that exerts the greatest influence on most of us. If we are not ill or deprived of basic necessities, if the body is content, we virtually ignore it. The mind, however, registers every event, no matter how small. Therefore we should focus our most serious efforts on bringing about mental peace."

If the body is not cared for, it will dominate our thoughts, of course. Too hungry and we can not concentrate; too tired and we can not make wise choices. No amount of mental peace will chance the body's needs.

However, as the Dalai Lama suggests, more often than not in our time and place, our dis-ease is caused by the mind. In this country (US) in this time (2000s), most people have more food than we need (although our access to healthy and whole food is much more limited), and need to engage in far less activity than our bodies need to get that food. Most (not all, but most) have adequate shelter and can clothe ourselves as is needed to protect our bodies from the elements. Most of the time, the stressors in our lives originate in our minds.

A mind-originating stress is not less valid than a body-based one. In fact, they are interconnected. Body-based dis-ease causes us to feel emotional and/or mental dis-ease, as I described already. Mind-based dis-ease causes physical symptoms and outcomes in the body. Chronic stress has been shown to have important outcomes: heart and blood pressure problems, less-healthy birth outcomes, blood sugar irregularity, etc. In fact, few if any body diseases lack a mental health component; almost all are impacted by stress. Also, when we are upset, we frequently crave the very things that are not good for us. For example, many people find stress directly impacts their appetite. We feel hungry, and crave foods that will make our bodies feel less good in the long run; or we feel disgusted by food and avoid eating when we need. The two are not readily separable. Since our bodies and minds are not separate beings, this should not be a surprise. However, we need to figure out if our hunger is for lack of food, for example, or from stress. The difference is not how important they are, but in how we address them.

When addressing dukkah, the Buddhist approach is most helpful in addressing the mental stresses. (Physical ones, of course, are more straight forward in terms of figuring out what to do. If food is needed, apply food. The challenge is in the circumstances that led to food not being available.) It is also a helpful approach in terms of figuring out if the source of the problem is the mind or the body.

In Buddhism, the belief is that mind-based dukkah is caused by a disconnect between what is real, and what we would like to be real. Therefore, the approach is to see, truly see, what is real. This is harder than it appears. The question is not what upsets you, but what is the situation -- from all angles. When we can see the situation this way, we will see the way to resolve our dis-ease as simply and clearly as solving a physical dis-ease.

To get to a place where we can see clearly enough to accomplish this feat, we need to quiet our minds: meditation. This is, essentially, the main reason that meditation has physical benefits -- because our minds and bodies are interconnected, and we need this clarity to resolve our mind-based dis-ease. Meditation can be done while sitting still with a quiet mind, or while walking or doing work with a quiet mind. Wash the dishes, just focusing on the dish in front of you. "I am washing this glass. Soap, water, warm, cool."

Dukkah is typically personal: what is out of sync between my expectations and my life? However, as public health messages are crafted by people, that disconnect can, and does, happen in our work. When our messages are not reaching people we have to ask ourselves the same kinds of questions. To see the context of the health behavior we want to impact clearly, we must start by listening and observing clearly, without expectations. Without that, we will not reach our audience. If we have not listened clearly, we can not expect to be heard.

Buddhism for public health, part 2

Nonpermanence

The Buddhist philosophy says that permanence is an illusion that we cling to, and that clinging to it causes us suffering. Either we are so focused on the future that we miss the now, or we try to make things stay the way they are. Both approaches to fixing this problem become suffering. Some Buddhists remind themselves of this principle by placing cut flowers on their altar or shrine. As the flowers rapidly change from young, to full-bloom, to waning, and desiccated, there is no denying the changes.

Living things are constantly changing. Cells grow and age, are replenished and replaced. Our systems are responding to constantly changing stimuli and context, and therefore are changing. All living things are always aging, growing, shrinking, getting stronger and weaker, moving through cycles, and passing through stages of existence.

As living things, we as individuals have ideas about our bodies that are based on past experiences. Ideas about our body types, our capabilities, what is normal for us, become part of our identity. Experience is of course a critical teacher. However, if we are not currently listening to our bodies, those ideas can quickly become mistaken. I still think of myself as a tree-climber, a monkeybar-swinger. As I am nearing 40 years of age, I must recognize that this no longer true for me. Many other changes are more critical to our health for us to notice. Digestive processes, reproductive systems, our heart and circulatory system, muscles and bones, are all in need of our awareness of changes as time passes.

As public health professionals, it is important for us to be aware of how audiences see themselves, which may be based on their past instead of their present. However, the physical world is not the only one that changes; the psychosocial landscape is also constantly in flux. As I sat training a new qualitative data collector, I realized this important way in which we need to remember nonpermanence in our work. When we collect data, the information we are collecting is true for the person we are listening to, at the time we are listening.

As we prepare to ask recent fathers about their prenatal and postnatal experiences with breastfeeding information and infant feeding, we must remember that what they tell us is true today. Two months ago, they may have said something different. Two weeks from today, they may tell another story. Today, this is his truth.

It is easy, as professionals, to feel that we know a population, a community, and how it perceives a topic. However, that answer is inherently yesterday's answer (or, more likely, last year's). The value of qualitative research is that we find what today's truth is. To communicate with our audiences in the present, we need that knowledge.

Buddhism for public health

What is Buddhism? A religion? A culture? A philosophy? In many ways it is all of these, but as Adrienne Howley describes best in "The Naked Buddha," at its heart it is a philosophy, an approach to life and a way of understanding what we perceive.

The basic message is that we all suffer, and that the way out of suffering is to adjust to how life is instead of how we would have it be. The many steps to achieving this escape from suffering involve specifically perceiving our selves, our surroundings, and each other clearly, honestly and without judgement. It sounds simple, but it is extremely difficult to do. Even just looking myself straight on without either excuses or judgements is a huge challenge. How do I begin to apply this embrace to my environment? My loved ones? Strangers?

So, the question might be Why bother?, or How could doing so have anything to do with public health? This is a complex and multi-level conversation, so I would like to try one piece at a time. Here is the first piece of this puzzle:

Interconnectedness: Within the Buddhist philosophy, we are all connected with each other. We are of this planet, subsist on this planet, and will return to this planet. On a microbial level, the planet is on and in us. We are on and in the planet.

As we look at non-human ecosystems (lakes, woods, deserts, oceans), we are learning that that which impacts one member of the ecosystem impacts the whole. Take out the jelly fish, and their competitors, their prey, their prey's competitors, and their predators are all immediately impacted. Soon, the entire ocean is different.

Ultimately, public health is the health of each of us as a community. When we neglect members of our ecosystem -- our community -- the impact is immediately upon us all. When we allow some people to be treated less, we are all lessened. Understanding this, communicating this message, can be a key to changing our public health messages from blaming or helplessness to mutual benefit.

We also all need each other. This means that promoting healthy individuals and individual choices needs to reconnect us. We are living in a disconnected environment, where people too often do not know their neighbors. Research shows that people need community, need each other; elderly people who are connected to others -- family, religious organizations, volunteer work -- are healthier than their disconnected peers. We need health promotion that builds upon and strengthens our communities.

So, as a starting place, we need to start thinking of ourselves not as separate individuals, but as unique expressions of a larger whole. When we do, we realize that others are not other. Connecting to each, we can support each other and be stronger for it.

Health Care For All

While it is an amazing thing that the Obama administration is taking on our health care system at this time, that a politician is willing to tackle such a daunting task, I have to ask why. Why would it be unpopular with people (voters) to make access to health care providers available to everyone? What are the real benefits and costs to the average person and to the community at large in providing everyone with health care access in the form of insurance?

First, while most people who have insurance assume they always will, this is not true. If you work for a small company, that company may find it too expensive to maintain access -- poof, your insurance is gone. An accident or illness can either take you out of the workforce unexpectedly, or can be reason for an insurer to discontinue services -- poof. You can lose your job (yes, even you), and -- poof. You can find yourself under-employed -- poof. You could easily find ourself among the uninsured. Many Americans spend some portion of their adult wage-earning years uninsured. If they are lucky, they won't need health care during that time. However, luck is not dependable.

Second, people who do not have health insurance are part of our community and still need health care. When people do not have a regular provider, someone to call when a health problem first arrises, they frequently go without care. After time, the problem usually gets worse for neglect, and eventually, the problem becomes an emergency. Emergency room care is more expensive, for both the individual and the community, financially and physically. Frequently problems that were easily treatable earlier become expensive, painful, traumatic experiences by the time they are seen in the ER. Other times they are fatal. Privacy is limited; continuity of care is even more limited; other infections are usually available to pick up while you visit. And all at an astronomical cost.

The one advantage in an emergency room is that you can't be turned away. Whether you can pay or not, whether you have coverage or not, you will get the care you need.

As a community, we all pay for this higher-cost care. We also all pay for the disability and decreased productivity that happens when diseases and injuries are allowed to get worse (for lack of other options).  Preventative care, early detection, regular check-ups, all cost far less than emergency care for late-stage diagnosis and treatment. If we vote only from self-interest, it is in our interest to make sure that everyone in our community (which is the nation if we are honest with ourselves) has access to health care.

Let's pay less by taking better care of each other from the start.