55-M3-7-2 Health Equity and Social Justice The garment industry in Bangladesh has a longstanding history of corruption, which further eroded when the industry went into partnership with a corrupt customer base who sought quality craftsmanship at an exceptionally cheap rate. The result culminated in a “totally flawed industry structure where sewers are forced work up to 16 hours a day, 7 days a week in terrible conditions” (Birnbaum, 2014, p. 1). Subsequently, until the government of Bangladesh takes an active interest in identifying and abolishing the laws and programs that promote corruption, the workforce will never achieve health equity and social justice (Pulok & Ahmed, 2017). With that said, given the current state of union suppression (arrest of 34 union organizers), penal governance, low wages, unsafe and unhealthy working environments, and worker persecution, it appears, leaders have little if any interest in the implementation of global health policies aimed at improving the health and well-being of their workers (Human Rights Watch, 2017). Notably, widespread corruption within the industry gives way to the suppression of health equity and social justice, which collectively nurtures an environment that bears considerable responsibility for the burden of tuberculosis (TB) currently witnessed among garment factory workers. Important to note, TB outbreaks are linked to overcrowding, poor ventilation, poor working conditions, poverty, malnutrition, and an imbalanced healthy workforce, all of which are conditions impacting the garment factory workforce (Bangladesh Garment Manufacturers and Exporters Association, 2015). With that said, when considering the inclusive elements of health equity (poverty, discrimination, powerlessness, good jobs with fair pay, safe working environments, etc.), we can safely deduce the lack of health equity (a product of corruption) plays an important role in TB burden among garment factory workers given they do not have a fair and just opportunity to be healthier (Robert Wood Johnson Foundation, 2017). Building on the later, it’s important to examine the elements of social justice or lack thereof given its contribution to placing garment factory workers at an increased risk for TB. Social justice, as a concept, suggests that individuals “have equal rights and opportunities; everyone, from the poorest person on the margins of society to the wealthiest, deserves an even playing field” (Wise Geek, 2017, para. 2). However, social justice is not something afforded to the garment factory workforce when considering both industry leaders and the government continually fail to implement policies that would effectively level the playing field. Subsequently, the absence of health equity and social justice within this industry serves to suppress and marginalize the health and well-being of workers, which in turn, places them at an increased risk of disease (TB in this instance), death or disability. Thus, for this wor.

1. 55-M3-7-2
Health Equity and Social Justice
The garment industry in Bangladesh has a longstanding history
of corruption, which further eroded when the industry went into
partnership with a corrupt customer base who sought quality
craftsmanship at an exceptionally cheap rate. The result
culminated in a “totally flawed industry structure where sewers
are forced work up to 16 hours a day, 7 days a week in terrible
conditions” (Birnbaum, 2014, p. 1). Subsequently, until the
government of Bangladesh takes an active interest in identifying
and abolishing the laws and programs that promote corruption,
the workforce will never achieve health equity and social justice
(Pulok & Ahmed, 2017).
With that said, given the current state of union suppression
(arrest of 34 union organizers), penal governance, low wages,
unsafe and unhealthy working environments, and worker
persecution, it appears, leaders have little if any interest in the
implementation of global health policies aimed at improving the
health and well-being of their workers (Human Rights Watch,
2017). Notably, widespread corruption within the industry gives
way to the suppression of health equity and social justice, which
collectively nurtures an environment that bears considerable
responsibility for the burden of tuberculosis (TB) currently
witnessed among garment factory workers.
Important to note, TB outbreaks are linked to overcrowding,
poor ventilation, poor working conditions, poverty,
malnutrition, and an imbalanced healthy workforce, all of which
are conditions impacting the garment factory workforce
(Bangladesh Garment Manufacturers and Exporters Association,
2015). With that said, when considering the inclusive elements
of health equity (poverty, discrimination, powerlessness, good
jobs with fair pay, safe working environments, etc.), we can
safely deduce the lack of health equity (a product of corruption)
plays an important role in TB burden among garment factory

2. workers given they do not have a fair and just opportunity to be
healthier (Robert Wood Johnson Foundation, 2017).
Building on the later, it’s important to examine the elements of
social justice or lack thereof given its contribution to placing
garment factory workers at an increased risk for TB. Social
justice, as a concept, suggests that individuals “have equal
rights and opportunities; everyone, from the poorest person on
the margins of society to the wealthiest, deserves an even
playing field” (Wise Geek, 2017, para. 2). However, social
justice is not something afforded to the garment factory
workforce when considering both industry leaders and the
government continually fail to implement policies that would
effectively level the playing field.
Subsequently, the absence of health equity and social justice
within this industry serves to suppress and marginalize the
health and well-being of workers, which in turn, places them at
an increased risk of disease (TB in this instance), death or
disability. Thus, for this workforce, there’s no sign of relief
inside or outside the workplace. Markedly, at the nucleus of this
issue, you find both industry and government corruption, which
is designed to prevent a shift in power to those possessing a
genuine interest to improve working conditions and wages,
which in turn leads to advanced health and well-being.
Importantly, health equity and social justice commonly occur
when those in charge possess some semblance of a moral
compass, yet, this industry lacks a moral compass; thus,
indicating a dire need within this industry for legislation to
address the issues of equity and justice. Until such a time this
comes to fruition garment factory workers will never recognize
the benefits associated with an even playing field; thus, their
health, safety, and well-being remain in peril.
Reference
Birnbaum, D. (2014). Corruption and the Garment Industry.
Retrieved from

3. http://www.birnbaumgarment.com/2014/06/25/corruption-and-
the-garment-industry/
Human Rights Watch. (2017). Bangladesh: Stop persecuting
unions, garment workers. Retrieved from
https://www.hrw.org/news/2017/02/15/bangladesh-stop-
persecuting-unions-garment-workers
Pulok, M. H., & Ahmed, M. U. (2017). Does corruption matter
for economic development? Long run evidence from
Bangladesh. International Journal Of Social Economics, 44(3),
350-361. Retrieved from doi:10.1108/IJSE-05-2015-0132
Robert Wood Johnson Foundation. (2017) What is health equity.
Retrieved from
https://www.rwjf.org/en/library/research/2017/05/what-is-
health-equity-.html
Wise Geek. (2017). What is social justice. Retrieved from
http://www.wisegeek.org/what-is-social-justice.htm
55-J-7-1
Over the past few years mental health illness and violence has
been a highly talked about topic. After doing some research, it
was concluded that a majority of the people that are affected by
this reside in low-income countries where their access to
resources are very limited (Collins et al., 2011). Through my
research many of the policies that were spoken about included
policies that included, gun reporting laws and gun laws around
individuals with mental illness. One organization that spoke
about these policies was the National Alliance on Mental Illness
(NAMI). NAMI is a national alliance that has a mission that
provides advocacy, education, support and public awareness so

4. that all individuals and families affected by mental illness can
build better lives (NAMI, 2019). What makes this particular
organization successful is that they hold a high priority on
education. NAMI offers education throughout thousands of
communities across the United States through NAMI State
organizations and NAMI Affiliates (NAMI, 2019). They look to
ensure that communities and anyone in need is getting the right
support and education that is needed.
Now, if I was to make recommendations to organizations and
stakeholders. I would recommend that they look to make sure
funds and resources are there. If the programs ever saw that
they were running out of resources and funds I would look to
policy holders to see if a budget can be put in place to make
sure organizations like NAMI stay up and running. Having
organizations like NAMI stay around and continue to provide
vital information is highly important when looking to improve
mental health illness and violence throughout countries.
Without proper education, support and resources, this issue will
continue to happen. But the only way to keep organizations like
this running are through proper funding and support. One top
way to have policy holders and organization runners understand
the importance is to have individuals affected speak on how the
program has helped them, families speak on how the programs
have supported them and even organization leaders from
programs like NAMI, speak on behalf of their statistics and
what success rates are for them.

5. References
Collins, P. Y., Patel, V., Joestl, S. S., March, D., Insel, T. R., &
Daar, A. S. (2011). Grand challenges in global mental health: A
consortium of researchers, advocates and clinicians announces
here research priorities for improving the lives of people with
mental illness around the world, and calls for urgent action and
investment. Nature, 475(7354), 27–30.
http://doi.org/10.1038/475027a
NAMI. (2019). Violence and Gun Reporting Laws.
https://www.nami.org/About-NAMI.
54-M3-7-2
Between 2000-2013, an analysis of Florida Poison Control
Centers regarding calls that were made about informational
queries and exposure-report calls about mercury. The data used
to analyze the calls to the Florida Poison Control Centers were
entered in ToxSentry which is a standardized data base. Once
the data was de-identified the calls were put into two
categories; exposure or informational. There were 3,573
mercury related calls between 2000-2013, 82% of those calls
were exposure-related calls while 18% of the calls were for
informational purposes. To compare, in 2003 469 calls about
mercury were recorded however in 2013 only 136 calls were
mercury related. (see table below) (Gribble, M. O., Hunter, C.
M., Deshpande, A., Stephan, W. B., & Weisman, R. S.) The

6. analysis concluded that while calls regarding mercury exposure
was found to have decreased, the number of informational
queries have increased. The Food Safety Surveys produced
national data that shows an increase in awareness of mercury in
seafood in the parents of small children in contrast recent
surveys of a region near Pensecola, Florida shows only 31% of
women are aware of mercury in seafood.
In 2010, an informational campaign called “Don’t mess with
Mercury” regarding mercury exposure was released that may
have contributed to the changes over time in the mercury related
calls to the Florida Poison Control Centers. The limitations that
were found with this analysis included, limited ability to assess
if the informational campaign had any influence on the number
of informational calls that were received, there may have also
been a misclasification of the mercury exposure related calls
(Gribble, M. O., Hunter, C. M., Deshpande, A., Stephan, W. B.,
& Weisman, R. S.) Another limitation found with this analysis
is the fact that there are other numbers that the residents of
Florida could have called to report mercury exposure and seek
information regarding mercury.
The National Health and Nutrition Examination Survey’s
(NHANES) data was used from 1999-2010 to determine trends
in women 16-49 who lived in different regions in the United
States(Cusack, L. K., Smit, E., Kile, M. L., & Harding, A. K.
2017). This data looked at blood mercury and it also looked
specifically at age, race/ethnicity, socioeconomic status and the
consumption of fish and it also took into account variables
depending on geographic location. An interview was done that
asked the women about their consumption of fish or shellfish in
the last 30 days. They were specifically asked about 31 types of
fish consumed in the last 30 days. The data that was used for
calculations included frequency of consumption and type of fish
consumed. The type of fish consumed was broken down into
categories; tuna, predatory fish, marine fish, freshwater fish and

7. marine shellfish. The total blood mercury as well as blood
inorganic mercury was also measured in this analysis. The
analysis found that women in the Northeast had the highest
percentage of blood mercury concentrations while women in the
midwest had the lowest percentage of blood mercury
concentrations.
Fig. 1 A map of whole blood mercury concentration (geometric
mean and 95% Confidence Interval (μg/L)) in women of
childbearing ages by coastal/inland regions for NHANES 1999–
2010
Shellfish was found to be the most consumed fish in all regions
except Inland West and Inland Midwest. Women living in the
Gulf of Mexico was found to consume freshwater fish the most,
marine fish was found to be consumed most often by women
living in the Pacific Coast region. The consumption of tuna was
most often consumed in the Great Lakes Region and shellfish
was found to be most often consumed in the Gulf of Mexico
region. According to the data the consumption of fish increased
as age and household income increase. Mexican Americans were
found to consume the least amount of fish monthly while
participants that identified as either Other, Asian American,
Pacific Islander, Alaska natives and Native Americans were
found to consume the most total fish on a monthly basis. Non-
Hispanic Blacks were found to consume the most fresh water
fish in the past 30 days (Cusack, L. K., Smit, E., Kile, M. L., &
Harding, A. K. 2017).
The NHANES analysis concluded that although fish
consumption is increasing, whole blood levels are decreasing
however a substantial number of U.S. women have blood
mercury levels above the EPA’s reference level. It was also
concluded that the women are not eating the amount of fish
recommended by the American dietary guidelines, which is
twice a week.

8. Fig. 2 Distribution of Total Blood Mercury (ug/L), by NHANES
survey cycle, for women of childbearing age
Fig. 4 Distribution of total fish consumption (meals per month),
by NHANES survey cycle, for women of childbearing age
The ecological perspective may have been used to predict the
trends that were identified. This theory looks at multiple factors
that influence the way people interact with both their physical
and socio-cultural environments. When looking at mercury
related exposure you have to consider the many factors that are
involved including; form of mercury exposure, age of person
exposed, how the exposure occurred, length of exposure, co-
morbidities of the person exposed and the amount of exposure.
When you consider these factors, it will allow you to gain a
better understanding about mercury related exposure and how it
occurs. Being able to monitor or predict the environmental
health trends when it relates to mercury is very important.
Healthcare professionals and researchers need to work more
closely together to help fill the gaps in knowledge as it relates
to mercury exposure. Increasing awareness through national or
local campaigns in regards to mercury related exposure allows
one to make informed decisions and would be considered a
proactive solution to the problem that will help to develop
future interventions.
Reference
Bjørklund, G., Dadar, M., Mutter, J., Aarseth, J., The
toxicology of mercury: Current research and emerging trends,
Environmental Research, Volume 159, 2017, Pages 545-554,
ISSN 0013-9351
Cusack, L. K., Smit, E., Kile, M. L., & Harding, A. K. (2017).
Regional and temporal trends in blood mercury concentrations
and fish consumption in women of child bearing Age in the

9. United States using NHANES data from 1999-2010.
Environmental Health: A Global Access Science Source, 161-
11. doi:10.1186/s12940-017-0218-4
Gribble, M. O., Hunter, C. M., Deshpande, A., Stephan, W. B.,
& Weisman, R. S. (n.d). Calls to Florida Poison Control Centers
about mercury: Trends over 2003-2013. Environmental
Research, 159422-426.
54-J-7-1
The Wasco-Sherman Public Health Department in Oregon
deemed the Salmonellosis outbreak as an intentional poisoning
of restaurant salad bars in the community of Dalles. Members of
the Rajneeshpuram group committed this malicious act. From a
public health perspective, the health department followed
proper channels of an outbreak investigation through laboratory
methods and the appropriate statistical analysis of all data- from
the food, employees, and customers/patients, whom met the case
definition with onset symptoms. The local and state health
department worked in conjunction with the criminal
investigation team as well, which is very important when it
comes reporting uncommon disease or illness clusters. The
epidemiologic practice to an occurrence need not be changed;
and the processes of determining the pathogen, vehicle, and
route of contamination and relating them to time, places, and
person should remain the same (Torok et al., 1997). In order to
prevent “terrorism by food” situations in the future, a food
defense strategy will utilize sensible and cost-effective channels
to reduce the risk of a spiteful contamination. Prevention
measures will entail secure video footage to monitor food
delivery, food preparation and the food consumption, along with
two extensive trainings for employees. One will be to detect and

10. report signs of food meddling and the other will be an employee
health safety and precaution on how to safely use cleaning
materials, disposal of any chemical hazards and performing
proper hygiene. An additional measure would entail a staffing
order when it comes to meetings, clean employee attire,
identification (i.e. ID badges), and proper vetting, such as
criminal background checks.
A food defense program is a justifiable recommendation to all
entities handling foods and beverages because it addresses all
aspects of an operational system from security, personnel and
the physical products (i.e. food, drinks, etc.). It’s imperative for
all businesses serving food and beverages to have a viable food
defense plan that meets applicable standards to protect the
consumers and the employees, and the facility’s integrity. The
Nevada Food Safety Task Force (NFSTF), put in place by the
Nevada Division of Public and Behavioral Health (DPBH),
which does adhere to the United States Food and Drug
Administration’s (FDA) standards, regulates all food
establishments and the administration of interventional
practices, such as a food defense plan. These same agencies,
including local health departments, such as the Southern Nevada
Health District in Southern Nevada, also monitors the success
of all strategies and programs; therefore, they would assess the
food defense recommendation by making visits to perform
evaluations. Evaluations of an establishment’s whole system
and their measures, such as checking on licensing, making sure
trainings are up-to-date and auditing the food defenses
procedures and practices of all staffing. Additionally, ratings
should be distributed in order to challenge all food and
beverage companies to strive for 100% satisfaction of food
defense adherence- ratings will be available to the public for
their own knowledge and well-being, which will retract or
retain business. Furthermore, there could even be an incentive
program implemented to encourage continuous improvement
and devotion to healthier communities by means of protection
and the fight against “terrorism by food.”

11. Reference
Török, T. J., Tauxe, R., Wise, R., Livengood, J., Sokolow, R.,
Mauvais, S., Birkness, K.
(1997). A Large Community Outbreak of Salmonellosis Caused
by Intentional
Contamination of Restaurant Salad Bars. JAMA: The Journal of
the American Medical Association, 278(5), 389.
doi:10.1001/jama.1997.03550050051033