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Could a CA bill on tortillas improve maternal health?

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Monday, April 15, 2024

A premature baby in incubator. Photo via iStock California is struggling to provide maternal health for its residents. But as one proposal aims to prevent birth defects, another has received hateful pushback that’s been condemned by both political parties. As CalMatters health reporter Ana B. Ibarra writes, Assemblymember Joaquin Arambula has introduced a bill that would require corn masa flour makers to add 0.7 milligrams of folic acid per pound of flour. Though federal law requires other grain products, such as cereals, breads and pasta, be fortified with folic acid, corn masa flour is not included. The corn flour is a key ingredient used in many classic Latino foods. Arambula, a Fresno Democrat and physician, to CalMatters: “Food is the best way that we can get folic acid into our communities before they’re pregnant. Oftentimes the prenatal vitamins that we give to pregnant people are too late.”  Research has shown that folic acid, which can be found in prenatal and women’s multi-vitamins, promotes healthy cell growth, and can prevent birth defects when taken before and during the early weeks of pregnancy. Since 1998, when the U.S. Food and Drug Administration handed down the requirement, the proportion of babies born with neural tube defects dropped by 35%. But between 2017 and 2019, only about 28% of Latinas reported taking folic acid the month before becoming pregnant, compared to 46% of white women. Women on Medi-Cal, the state’s health insurance program for low-income families, are also less likely to take folic acid before pregnancy compared to women on private insurance.  To learn more about the proposal, read Ana’s story. Another bill related to maternal health, Assembly Bill 2319, was the subject of a racist letter sent to members of the Health Committee, according to lawmakers. The measure would require healthcare providers to undergo training for implicit bias, and for the training to include “recognition of intersecting identities.”  The bill’s co-author, Assemblymember Lori Wilson, said the letter was “vile and hateful.” Assembly Republicans also said the letter had no place in legislative debate: “While we may not always agree on policy, we are united to strongly condemn racism and the evil ideology behind this letter.” Wilson, a Suisun City Democrat who is chairperson of the Legislative Black Caucus, vowed to carry on with the measure. The proposals by Arumbula and Wilson follow state data showing that in 2020 California saw a ten-year high of pregnancy-related deaths. Black expectant mothers are particularly vulnerable: They are three times more likely to die of pregnancy-related complications than others. It’s a point raised by former state Senate leader Toni Atkins in a social media post last week. Meanwhile, maternity wards across the state are closing, creating “maternity care deserts,” and California midwives treating Medi-Cal patients struggle to keep their businesses afloat. A February report from the state auditor also found that state health departments failed to track the effectiveness of a perinatal care program for Medi-Cal patients. Digital Democracy: CalMatters has launched Digital Democracy, a project using the latest technologies to help Californians understand their state government and create more accountability for politicians. The website introduces each of the state’s 120 legislators and explains this year’s policy agenda. In our unprecedented database, you can instantly find any word uttered in a public hearing, every vote cast, every bill introduced and every dollar donated. For more details, see our about and methodology pages and read more from our engagement team. Other Stories You Should Know Builders can challenge impact fees New housing construction in a neighbourhood in Elk Grove on July 8, 2022. Photo by Rahul Lal, CalMatters From CalMatters housing reporter Ben Christopher:It’s about to get more difficult for local governments to slap construction projects with certain fees — and a bit easier for developers to sue governments when they do.  That’s thanks to a unanimous ruling the U.S. Supreme Court handed down Friday. As many court watchers expected, the justices sided with George Sheetz, a septuagenarian retiree who sued El Dorado County over a $23,420 building fee. Sheetz’s lawyers argued that the county should have had to prove that this five-digit fee matched the cost that his manufactured home actually would inflict on local roads and highways. That requirement was established in a four-decade-old court ruling also out of California. El Dorado County, with the backing of both the Gov. Gavin Newsom and President Joe Biden administrations, countered that such a high bar is only required of one-off fees levied by regulators, not fees scheduled for all developments and established by elected bodies, like the county board of supervisors. In its 9-0 ruling, the Supreme Court said that “there is no basis for affording property rights less protection in the hands of legislators than administrators.” A few possible consequences of the ruling: Cities and counties now have to show that impact fees are connected to and “roughly proportionate” to the fiscal impact of a given development. That could have the unintended consequence of slowing down permitting.  Developers may now have a powerful new legal tool to challenge fees that they think are too high. And they are high here. As of 2015, the average impact fee on a single family home in California was more than four times the national average. But it’s too soon to say exactly how all of this will shake out. That’s because the court stopped short of saying exactly how far governments have to go to justify their fees — or whether El Dorado County already cleared that hurdle in this case. Those questions were left to lower courts. State cracks down on water Armona’s new $9 million well and treatment facility to remove arsenic in its water supply. Photo by Larry Valenzuela, CalMatters/CatchLight Local The State Water Resources Control Board is poised to penalize Kings County groundwater agencies for failing to manage overpumping in the region’s water supply — a move that would set a new precedent. As CalMatters water reporter Rachel Becker explains, the board on Tuesday is expected to decide whether to put county agencies on probation for unsuccessfully restricting farmers’ overdrafting of the water supply from the Tulare Lake underground basin. If the board decides to crack down, it will be the first time the state imposes penalties under a landmark 2014 law that requires agencies to achieve groundwater sustainability by 2040.The board’s decision could also signal how the state will approach five other overpumped San Joaquin Valley basins that may face probation as well. Overpumping in Kings County has caused household and community water wells to dry up and land to sink, which endangers canals, aqueducts and flood-controlling levees. And because wells must reach deeper into the ground to extract water, contaminants such as arsenic are released and cause water contamination levels to rise. Putting Kings County agencies on probation could mean imposing state fees totaling as much as $10 million a year, according to a CalMatters analysis. It could also lead to state regulators eventually managing the region’s groundwater. This has small farmers in the region concerned that they’ll be forced out of business due to the state’s steep fees. The basin provides drinking and irrigation water for 146,000 residents and supports a multibillion-dollar agricultural industry. For more on this issue, read Rachel’s story. California’s water crisis, explained: CalMatters has a detailed look at how California might increase its water supply, and a dashboard tracking the state’s water situation. CalMatters Commentary Ideas festival: CalMatters is hosting its first one, in Sacramento on June 5-6. It will include a discussion on broadband access and a session with Zócalo Public Square on California’s next big idea. Featured speakers include Julián Castro, CEO of the Latino Community Foundation, and Barbara McQuade, a former U.S. attorney and MSNBC legal analyst. Find out more from our engagement team and buy tickets here. Other things worth your time: Some stories may require a subscription to read. CA granted federal disaster relief for historic February storms // Los Angeles Times  Ballot measure for America’s highest wage could be victim of past wins // Politico Prop. 22 gains liberal support as case heads to state high court // San Francisco Chronicle PG&E customers were billed for a TV promo campaign // The Sacramento Bee Google blocks some CA news as fight over online journalism bill escalates // Politico Bill to mandate ‘science of reading’ in CA classrooms dies // EdSource CA abortions increased after Roe vs. Wade was overturned // Los Angeles Times The first high-speed rail trains are closer to coming to CA // San Francisco Chronicle Environmental concerns raised by rocket flights // The San Diego Union-Tribune SF jails lock down after alleged assaults on staff // Los Angeles Times SF background check startup Checkr cutting 260 jobs // San Francisco Examiner SF $2B Central Subway has lots of leaks, few riders // The San Francisco Standard Kern County activist faces 18 felony counts over alleged threats // Los Angeles Times Former Windsor mayor’s accusers speak out on no charges // San Francisco Chronicle

California is struggling to provide maternal health for its residents. But as one proposal aims to prevent birth defects, another has received hateful pushback that’s been condemned by both political parties. As CalMatters health reporter Ana B. Ibarra writes, Assemblymember Joaquin Arambula has introduced a bill that would require corn masa flour makers to add […]

A premature baby in incubator. Photo via iStock
A premature baby in incubator. Photo via iStock
A premature baby in incubator. Photo via iStock

California is struggling to provide maternal health for its residents. But as one proposal aims to prevent birth defects, another has received hateful pushback that’s been condemned by both political parties.

As CalMatters health reporter Ana B. Ibarra writes, Assemblymember Joaquin Arambula has introduced a bill that would require corn masa flour makers to add 0.7 milligrams of folic acid per pound of flour. Though federal law requires other grain products, such as cereals, breads and pasta, be fortified with folic acid, corn masa flour is not included. The corn flour is a key ingredient used in many classic Latino foods.

  • Arambula, a Fresno Democrat and physician, to CalMatters: “Food is the best way that we can get folic acid into our communities before they’re pregnant. Oftentimes the prenatal vitamins that we give to pregnant people are too late.” 

Research has shown that folic acid, which can be found in prenatal and women’s multi-vitamins, promotes healthy cell growth, and can prevent birth defects when taken before and during the early weeks of pregnancy. Since 1998, when the U.S. Food and Drug Administration handed down the requirement, the proportion of babies born with neural tube defects dropped by 35%.

But between 2017 and 2019, only about 28% of Latinas reported taking folic acid the month before becoming pregnant, compared to 46% of white women. Women on Medi-Cal, the state’s health insurance program for low-income families, are also less likely to take folic acid before pregnancy compared to women on private insurance. 

To learn more about the proposal, read Ana’s story.

Another bill related to maternal health, Assembly Bill 2319, was the subject of a racist letter sent to members of the Health Committee, according to lawmakers.

The measure would require healthcare providers to undergo training for implicit bias, and for the training to include “recognition of intersecting identities.” 

The bill’s co-author, Assemblymember Lori Wilson, said the letter was “vile and hateful.”

Assembly Republicans also said the letter had no place in legislative debate: “While we may not always agree on policy, we are united to strongly condemn racism and the evil ideology behind this letter.”

Wilson, a Suisun City Democrat who is chairperson of the Legislative Black Caucus, vowed to carry on with the measure.

The proposals by Arumbula and Wilson follow state data showing that in 2020 California saw a ten-year high of pregnancy-related deaths. Black expectant mothers are particularly vulnerable: They are three times more likely to die of pregnancy-related complications than others. It’s a point raised by former state Senate leader Toni Atkins in a social media post last week.

Meanwhile, maternity wards across the state are closing, creating “maternity care deserts,” and California midwives treating Medi-Cal patients struggle to keep their businesses afloat. A February report from the state auditor also found that state health departments failed to track the effectiveness of a perinatal care program for Medi-Cal patients.


Digital Democracy: CalMatters has launched Digital Democracy, a project using the latest technologies to help Californians understand their state government and create more accountability for politicians. The website introduces each of the state’s 120 legislators and explains this year’s policy agenda. In our unprecedented database, you can instantly find any word uttered in a public hearing, every vote cast, every bill introduced and every dollar donated. For more details, see our about and methodology pages and read more from our engagement team.


Other Stories You Should Know


Builders can challenge impact fees

New housing construction in a neighbourhood in Elk Grove on July 8, 2022. Photo by Rahul Lal, CalMatters

From CalMatters housing reporter Ben Christopher:

It’s about to get more difficult for local governments to slap construction projects with certain fees — and a bit easier for developers to sue governments when they do. 

That’s thanks to a unanimous ruling the U.S. Supreme Court handed down Friday.

As many court watchers expected, the justices sided with George Sheetz, a septuagenarian retiree who sued El Dorado County over a $23,420 building fee.

Sheetz’s lawyers argued that the county should have had to prove that this five-digit fee matched the cost that his manufactured home actually would inflict on local roads and highways. That requirement was established in a four-decade-old court ruling also out of California.

El Dorado County, with the backing of both the Gov. Gavin Newsom and President Joe Biden administrations, countered that such a high bar is only required of one-off fees levied by regulators, not fees scheduled for all developments and established by elected bodies, like the county board of supervisors.

In its 9-0 ruling, the Supreme Court said that “there is no basis for affording property rights less protection in the hands of legislators than administrators.”

A few possible consequences of the ruling:

  • Cities and counties now have to show that impact fees are connected to and “roughly proportionate” to the fiscal impact of a given development. That could have the unintended consequence of slowing down permitting. 
  • Developers may now have a powerful new legal tool to challenge fees that they think are too high.

And they are high here. As of 2015, the average impact fee on a single family home in California was more than four times the national average.

But it’s too soon to say exactly how all of this will shake out. That’s because the court stopped short of saying exactly how far governments have to go to justify their fees — or whether El Dorado County already cleared that hurdle in this case. Those questions were left to lower courts.

State cracks down on water

The water treatment facility in Armona on April 4, 2024. Armona, a small unincorporated community home to farmworkers in Kings County, had substantial arsenic contamination until a new $9 million well was installed more than 1,200 feet deep. Photo by Larry Valenzuela, CalMatters/CatchLight Local
Armona’s new $9 million well and treatment facility to remove arsenic in its water supply. Photo by Larry Valenzuela, CalMatters/CatchLight Local

The State Water Resources Control Board is poised to penalize Kings County groundwater agencies for failing to manage overpumping in the region’s water supply — a move that would set a new precedent.

As CalMatters water reporter Rachel Becker explains, the board on Tuesday is expected to decide whether to put county agencies on probation for unsuccessfully restricting farmers’ overdrafting of the water supply from the Tulare Lake underground basin. If the board decides to crack down, it will be the first time the state imposes penalties under a landmark 2014 law that requires agencies to achieve groundwater sustainability by 2040.

The board’s decision could also signal how the state will approach five other overpumped San Joaquin Valley basins that may face probation as well.

Overpumping in Kings County has caused household and community water wells to dry up and land to sink, which endangers canals, aqueducts and flood-controlling levees. And because wells must reach deeper into the ground to extract water, contaminants such as arsenic are released and cause water contamination levels to rise.

Putting Kings County agencies on probation could mean imposing state fees totaling as much as $10 million a year, according to a CalMatters analysis. It could also lead to state regulators eventually managing the region’s groundwater.

This has small farmers in the region concerned that they’ll be forced out of business due to the state’s steep fees. The basin provides drinking and irrigation water for 146,000 residents and supports a multibillion-dollar agricultural industry.

For more on this issue, read Rachel’s story.

California’s water crisis, explained: CalMatters has a detailed look at how California might increase its water supply, and a dashboard tracking the state’s water situation.


CalMatters Commentary

Ideas festival: CalMatters is hosting its first one, in Sacramento on June 5-6. It will include a discussion on broadband access and a session with Zócalo Public Square on California’s next big idea. Featured speakers include Julián Castro, CEO of the Latino Community Foundation, and Barbara McQuade, a former U.S. attorney and MSNBC legal analyst. Find out more from our engagement team and buy tickets here.


Other things worth your time:

Some stories may require a subscription to read.


CA granted federal disaster relief for historic February storms // Los Angeles Times 

Ballot measure for America’s highest wage could be victim of past wins // Politico

Prop. 22 gains liberal support as case heads to state high court // San Francisco Chronicle

PG&E customers were billed for a TV promo campaign // The Sacramento Bee

Google blocks some CA news as fight over online journalism bill escalates // Politico

Bill to mandate ‘science of reading’ in CA classrooms dies // EdSource

CA abortions increased after Roe vs. Wade was overturned // Los Angeles Times

The first high-speed rail trains are closer to coming to CA // San Francisco Chronicle

Environmental concerns raised by rocket flights // The San Diego Union-Tribune

SF jails lock down after alleged assaults on staff // Los Angeles Times

SF background check startup Checkr cutting 260 jobs // San Francisco Examiner

SF $2B Central Subway has lots of leaks, few riders // The San Francisco Standard

Kern County activist faces 18 felony counts over alleged threats // Los Angeles Times

Former Windsor mayor’s accusers speak out on no charges // San Francisco Chronicle

Read the full story here.
Photos courtesy of

Thousands of US Hazardous Sites Are at Risk of Flooding Because of Sea Level Rise, Study Finds

A new study finds that thousands of hazardous sites across the U.S. are at risk of flooding due to sea level rise that could pose public health threats to neighboring communities

If heat-trapping pollution from burning coal, oil and gas continues unchecked, thousands of hazardous sites across the United States risk being flooded from sea level rise by the turn of the century, posing serious health risks to nearby communities, according to a new study.Researchers identified 5,500 sites that store, emit or handle sewage, trash, oil, gas and other hazards that could face coastal flooding by 2100, with much of the risk already locked in due to past emissions. But more than half the sites are projected to face flood risk much sooner — as soon as 2050. Low-income, communities of color and other marginalized groups are the most at risk.With even moderate reductions to planet-warming emissions, researchers also determined that roughly 300 fewer sites would be at risk by the end of the century. “Our goal with this analysis was to try to get ahead of the problem by looking far out into the future," said Lara J. Cushing, associate professor in the Department of Environmental Health Sciences at the University of California, Los Angeles who co-authored the paper published in the science journal Nature Communications.“We do have time to respond and try to mitigate the risks and also increase resilience," she added, speaking at a media briefing Wednesday ahead of the study's release. The study was funded by the Environmental Protection Agency and builds on previous research from California. Climate change is driving and accelerating sea level rise. Glaciers and ice sheets are melting, and the sea's waters are expanding as they warm. In many places along the coastal U.S., sea level rise is accelerating faster than the global average because of things like erosion and land sinking from groundwater pumping, according to the National Oceanic and Atmospheric Administration. Thomas Chandler, managing director at the National Center for Disaster Preparedness at Columbia University who was not involved in the research, said it’s “a really important study” that the public, policy makers and government agencies “need to make note of.” Derek Van Berkel, an associate professor in the school for environment and sustainability at University of Michigan who was also not involved in the study, wasn't surprised to learn about the disproportionate risks. What was “alarming” was considering the magnitude of “feedback effects” from flooding, he said. How researchers approached the data The study's researchers started by identifying and classifying tens of thousands of hazardous sites near the coasts of Puerto Rico and the 23 states with coastline. Next, they wanted to know each site's projected future flood risk. They did this by calculating how likely each year coastal flooding could inundate a site using historical sea level measurements and projected sea level rise in 2050 and 2100 under low and high emissions scenarios. Lastly, they identified and classified communities as being at-risk if homes are located within 1 kilometer (0.62 miles) of a hazardous site with a high threat of future flooding, and compared those communities' characteristics with other coastal neighborhoods with no at-risk sites nearby. But researchers did not include all types of hazardous facilities, such as oil and gas pipelines, nor did they account for groundwater upwelling or more intense and frequent storms in the future, which could lead to underestimates. On the other end, the flood-risk model they used could have overestimated the number of threatened sites. “It is important to note that previous disasters, such as hurricanes Katrina, Rita and Harvey, did result in a lot of toxic contamination from oil and gas pipelines,” Chandler said. The 5,500 at-risk sites includes 44% that are fossil fuel ports and terminals, 30% power plants, 24% refineries and 22% coastal sewage treatment facilities. Most of the sites — nearly 80% — are in Louisiana, Florida, New Jersey, Texas, California, New York and Massachusetts. Potential health impacts from exposure to hazards People exposed to flood waters near industrial animal farms or sewage treatment plants could be exposed to bacteria like E. coli, said Sacoby Wilson, professor of global, environmental and occupational health at the University of Maryland during the briefing. Symptoms can include bloody or watery diarrhea, severe stomach cramps or vomiting and fever. Those living near industrial sites like refineries could be exposed to heavy metals and chemicals that can cause rashes, burning of the eyes, nose and throat, headaches or fatigue, added Wilson, who was not involved in the study. “For folks who are vulnerable, maybe have an underlying health condition, those health conditions could be exacerbated during those flood events.” Longer term, some of these exposures could contribute to cancer, liver, kidney or other organ damage, or have reproductive effects, he said. For Chandler, the Columbia University director, the study highlights the need to heavily invest in hazard mitigation. “It's really important for federal, state and local governments in the United States to address these factors through multi-stakeholder resilience planning and encouraging local governments to integrate climate risk assessments into their mitigation strategies.”The Associated Press receives support from the Walton Family Foundation for coverage of water and environmental policy. The AP is solely responsible for all content. For all of AP’s environmental coverage, visit https://apnews.com/hub/climate-and-environment.Copyright 2025 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.Photos You Should See – Nov. 2025

RFK Jr.’s Miasma Theory of Health Is Spreading

The agency is picking up Robert F. Kennedy Jr.’s argument that a healthy immune system can keep even pandemic germs at bay.

Last week, the two top officials at the National Institutes of Health—the world’s largest public funder of biomedical research—debuted a new plan to help Americans weather the next pandemic: getting everyone to eat better and exercise.The standard pandemic-preparedness playbook “has failed catastrophically,” NIH Director Jay Bhattacharya and NIH Principal Deputy Director Matthew J. Memoli wrote in City Journal, a magazine and website published by the Manhattan Institute for Policy Research, a conservative think tank. The pair argue that finding and studying pathogens that could cause outbreaks, then stockpiling vaccines against them, is a waste of money. Instead, they say, the United States should encourage people to improve their baseline health—“whether simply by stopping smoking, controlling hypertension or diabetes, or getting up and walking more.”On its own, Bhattacharya and Memoli’s apparently serious suggestion that just being in better shape will carry the U.S. through an infectious crisis is reckless, experts told me—especially if it’s executed at the expense of other public-health responses. In an email, Andrew Nixon, the director of communications at the Department of Health and Human Services—which oversees the NIH—wrote that the agency “supports a comprehensive approach to pandemic preparedness that recognizes the importance of both biomedical tools and the factors individuals can control.” But more broadly, Bhattacharya and Memoli’s proposal reflects the spread of a dangerous philosophy that Robert F. Kennedy Jr., the secretary of HHS, has been pushing for years: a dismissal of germ theory, or the notion that infectious microbes are responsible for many of the diseases that plague humankind.In his 2021 book, The Real Anthony Fauci: Bill Gates, Big Pharma, and the Global War on Democracy and Public Health, Kennedy, a longtime anti-vaccine activist, argues that modern scientists have blamed too much of infectious disease on pathogens, which he suggests are rarely problematic, unless the immune system has been compromised by poor nutrition, toxins, and other environmental stressors. He credits sanitation and nutrition for driving declines in infectious-disease deaths during the 20th century; vaccination, he has baselessly claimed, was largely ineffective and unnecessary. In his view, germs don’t pose a substantial threat to people who have done the work of “fortifying the immune system”—essentially, those who have taken their health into their own hands.In terms of general health, most Americans would benefit from improvements in diet and exercise. A strong emphasis on both has been core to the Make America Healthy Again movement, and in one important aspect, Kennedy and his allies are correct: The immune system, like other bodily systems, is sensitive to nutritional status, and when people are dealing with chronic health issues, they often fare less well against infectious threats, Melinda Beck, a nutrition and infectious-disease researcher who recently retired from the University of North Carolina, told me. Conditions such as obesity and diabetes, for instance, raise the risk of severe COVID and flu; malnutrition exacerbates the course of diseases such as tuberculosis and measles.But applied to widespread infectious outbreaks, the MAHA prescription is still deeply flawed. Being generally healthy doesn’t guarantee survival, or even better outcomes against infectious diseases—especially when an entire population encounters a pathogen against which it has no immunity. Although some evidence suggests that the 1918 flu pandemic strongly affected certain groups of people who were less healthy at baseline—including undernourished World War I soldiers—“relatively healthy people, as far as we could understand, were the main victims,” Naomi Rogers, a historian of medicine at Yale, told me. Smallpox, too, infected and killed indiscriminately. HIV has devastated many communities of young, healthy people.In his book, Kennedy relies heavily on the term miasma theory as a shorthand for preventing disease “through nutrition and by reducing exposures to environmental toxins and stresses.” He’s employing that phrase incorrectly: Historically, at least, miasma theory referred to the notion that epidemics are caused by bad air—such as toxic emanations from corpses and trash—and was the predominant way of describing disease transmission until scientists found definitive proof of infectious microbes in the late 19th century. But his choice of words is also revealing. In pitting his ideas against germ theory, he plays on a centuries-old tension between lifestyle and microbes as roots of illness.In its early days, germ theory struggled to gain traction even among physicians, many of whom dismissed the idea as simplistic, Nancy Tomes, a historian at Stony Brook University, told me. After the idea became foundational to medicine, scientists still had to work to convince some members of the public that microbes could fell healthy people, too. In the early days of polio vaccination, when the virus still ran rampant in the U.S., some vaccine-skeptical Americans insisted that children were falling seriously ill primarily because their parents weren’t managing their kids’ nutrition well and “had disrupted the child’s internal health,” Rogers told me.Over time, as pharmaceutical companies made global businesses out of selling antibiotics, vaccines, and antivirals, the products became a symbol, for some people, of how germ theory had taken over medicine. Accepting vaccines came to represent trust in scientific expertise, Rogers said; misgivings about the industry, in contrast, might translate into rejecting those offerings. In that skeptical slice of the American public and amid the rise of alternative-wellness practitioners, Kennedy has found purchase for his ideas about nutrition as a cure-all.Since taking over as health secretary, he has on occasion made that distrust in germ theory national policy. In his book, he wrote that “when a starving African child succumbs to measles, the miasmist attributes the death to malnutrition; germ theory proponents (a.k.a. virologists) blame the virus.” Earlier this year, when measles raged through undervaccinated regions of West Texas, the secretary acted out his own miasmist theory of the outbreak, urging Americans to rely on vitamin-A supplementation as a first-line defense, even though deficiency of that vitamin is rare here.But germ theory is key to understanding why outbreaks become pandemics—not because people’s general health is wanting, but because a pathogen is so unfamiliar to so many people’s immune systems at once that it is able to spread unchecked. Pandemics then end because enough people acquire sufficient immunity to that pathogen. Vaccination, when available, remains the safest way to gain that immunity—and, unlike lifestyle choices, it can represent a near-universal strategy to shore up defenses against disease. Not all of the risk factors that worsen disease severity are tunable by simply eating better or working out more. For COVID and many other respiratory diseases, for instance, old age and pregnancy remain some of the biggest risk factors. Genetic predispositions to certain medical conditions, or structural barriers to changing health habits—not just lack of willpower—can make people vulnerable to disease, too.In their article, Bhattacharya and Memoli purport to be arguing against specific strategies of pandemic preparedness, most prominently the controversial type of gain-of-function research that can involve altering the disease-causing traits of pathogens, and has been restricted by the Trump administration. But the pair also mischaracterize the country’s current approach to pandemics, which, in addition to calling for virus research and vaccine development, prioritizes measures such as surveillance, international partnerships, and improved health-care capacity, Nahid Bhadelia, the director of the Center on Emerging Infectious Diseases at Boston University, told me. And Bhattacharya and Memoli’s alternative approach cuts against the most basic logic of public health—that the clearest way to help keep a whole population healthy is to offer protections that work on a societal level and that will reach as many people as possible. Fixating on personal nutrition and exercise regimens as pandemic preparedness would leave many people entirely unprotected. At the same time, “we’re basically setting up society to blame someone” in the event that they fall ill, Jennifer Nuzzo, the director of the pandemic center at the Brown University School of Public Health, told me.Kennedy’s book bemoans that the “warring philosophies” of miasma and germ theory have become a zero-sum game. And yet, at HHS, he and his officials are presenting outbreak preparedness—and the rest of public health—as exactly that: The country should worry about environment or pathogens; it should be either pushing people to eat better or stockpiling vaccines. Over email, Nixon told me that “encouraging healthier habits is one way to strengthen resilience alongside vaccines, treatments, and diagnostics developed through NIH-funded research.” But this year, under pressure from the Trump administration, the NIH has cut funding to hundreds of vaccine- and infectious-disease focused research projects; elsewhere at HHS, officials canceled nearly half a billion dollars’ worth of contracts geared toward developing mRNA vaccines.The reality is that both environment and pathogens often influence the outcome of disease, and both should be addressed. Today’s public-health establishment might not subscribe to the 19th-century version of miasma theory, but the idea that environmental and social factors shape people’s health is still core to the field. “They’re saying you can only do one thing at a time,” Bhadelia told me. “I don’t think we have to.”

Clinicians can help address environmental toxics in reproductive health, international experts say

In a recent opinion paper published in the International Journal of Gynecology & Obstetrics, the International Federation of Obstetrics and Gynecology (FIGO) addresses how exposures to environmental toxics — including endocrine disrupting chemicals — have a wide range of impacts on reproductive health, and how clinicians can play a role in addressing this issue.In short: Extensive research has linked exposure to environmental toxics with an increased risk of polycystic ovary syndrome (PCOS), endometriosis, uterine fibroids, hormonally mediated cancers, menopause, and both female and male infertility. The key mechanisms behind these impacts include hormone disruption, oxidative stress, inflammation, and epigenetic changes that can affect multiple generations.FIGO emphasizes that harm from environmental toxics can be addressed, and that clinicians play a crucial role in ensuring environmental factors are meaningfully considered as a part of patient care. Key quote: “As trusted health advisors, obstetricians and gynecologists (OBGYNs) have an essential role in integrating environmental health into routine gynecologic and fertility care.” Why this matters: In this opinion paper, FIGO argues that clinicians should incorporate environmental health into routine care, and provides practical strategies to do so. Some of these strategies include taking environmental histories, counseling patients on risk reduction and healthy lifestyles, recognizing high-risk settings (e.g., occupational exposures), and advising patients on simple steps to reduce exposure — particularly during sensitive windows like preconception, pregnancy, puberty, and menopause. Clinicians should be aware of regional environmental health alerts, such as air quality advisories or contamination events. In addition, clinicians can advocate for policy change.Related EHN coverage: Chemical mixtures may impact fertility and IVF success, new study findsUnderstanding how the environment affects pregnant people’s healthMore resources: Additional International Federation of Obstetrics and Gynecology (FIGO) statements and opinions relating to the environment:FIGO opinion on reproductive health impacts of exposure to toxic environmental chemicalsFIGO calls for removal of PFAS from global useRemoval of glyphosate from global usageClimate Crisis and HealthStatement on Draft Strategy on health, environment and climate changeToxic chemicals and environmental contaminants in prenatal vitaminsDeNicola, Nathaniel et al. for International Journal of Gynecology & Obstetrics. Sept. 26, 2025

In a recent opinion paper published in the International Journal of Gynecology & Obstetrics, the International Federation of Obstetrics and Gynecology (FIGO) addresses how exposures to environmental toxics — including endocrine disrupting chemicals — have a wide range of impacts on reproductive health, and how clinicians can play a role in addressing this issue.In short: Extensive research has linked exposure to environmental toxics with an increased risk of polycystic ovary syndrome (PCOS), endometriosis, uterine fibroids, hormonally mediated cancers, menopause, and both female and male infertility. The key mechanisms behind these impacts include hormone disruption, oxidative stress, inflammation, and epigenetic changes that can affect multiple generations.FIGO emphasizes that harm from environmental toxics can be addressed, and that clinicians play a crucial role in ensuring environmental factors are meaningfully considered as a part of patient care. Key quote: “As trusted health advisors, obstetricians and gynecologists (OBGYNs) have an essential role in integrating environmental health into routine gynecologic and fertility care.” Why this matters: In this opinion paper, FIGO argues that clinicians should incorporate environmental health into routine care, and provides practical strategies to do so. Some of these strategies include taking environmental histories, counseling patients on risk reduction and healthy lifestyles, recognizing high-risk settings (e.g., occupational exposures), and advising patients on simple steps to reduce exposure — particularly during sensitive windows like preconception, pregnancy, puberty, and menopause. Clinicians should be aware of regional environmental health alerts, such as air quality advisories or contamination events. In addition, clinicians can advocate for policy change.Related EHN coverage: Chemical mixtures may impact fertility and IVF success, new study findsUnderstanding how the environment affects pregnant people’s healthMore resources: Additional International Federation of Obstetrics and Gynecology (FIGO) statements and opinions relating to the environment:FIGO opinion on reproductive health impacts of exposure to toxic environmental chemicalsFIGO calls for removal of PFAS from global useRemoval of glyphosate from global usageClimate Crisis and HealthStatement on Draft Strategy on health, environment and climate changeToxic chemicals and environmental contaminants in prenatal vitaminsDeNicola, Nathaniel et al. for International Journal of Gynecology & Obstetrics. Sept. 26, 2025

Thousands of Tunisian Doctors Strike, Say Health System Close to Collapse

By Tarek AmaraTUNIS (Reuters) -Thousands of young doctors went on strike across Tunisia on Wednesday to demand higher pay and warn of an impending...

TUNIS (Reuters) -Thousands of young doctors went on strike across Tunisia on Wednesday to demand higher pay and warn of an impending collapse of the health system, part of a broader wave of social unrest convulsing the country.A spate of environmental and anti-government protests prompted by a worsening economic crisis and disruptions in public services has posed the biggest challenge to President Kais Saied since he seized all power in 2021."We are exhausted, underpaid and working in a system that is breaking down," said Marwa, who declined to give her surname, while attending a protest rally in the capital Tunis with hundreds of other doctors."If nothing changes, more doctors will leave and the crisis will only deepen," she added.The protesters, wearing white coats, brandished placards that read "Dignity for doctors" and "Save our hospitals" as they gathered near Tunisia's parliament.As well as low wages, the protesters complained of outdated equipment and shortages of essential medical supplies, factors which they said were fuelling a growing exodus of young health professionals to Europe and the Gulf.“As long as the authorities ignore our demands, we will continue to escalate, resist and lead the social movement in the country," Wajih Dhakkar, head of the Young Doctors’ Organisation, told Reuters.The Health Ministry did not immediately respond to a request for comment.President Saied has accused what he describes as conspirators and infiltrators of fabricating crises in various sectors in order to undermine the state.Tunisia has seen strikes over pay by transport workers and bank employees in recent months, while the southern city of Gabes has been a focal point of protests over a pollution crisis blamed on a state-owned chemical plant.(Reporting By Tarek AmaraEditing by Gareth Jones)Copyright 2025 Thomson Reuters.Photos You Should See – Nov. 2025

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