Contagion and Epidemics

Contagion tracks the spread of a virus that appears to be contracted just through contact.  We watch as the CDC, WHO, and other health organizations struggle to stop the spread of the disease and provide the public with confidence.  Meanwhile, society begins to unravel and panic sets in across the world as people fight for their survival. 

Coming from a more scientific background, I found the story compelling and fairly accurate.  Even with multiple labs around the world trying to find the cure or a vaccine for a virus will take months, if not years.  The one thing that I felt bothered by in the movie was the lack of public involvement.  While it seemed like the government was concerned for the welfare of the people, it brought to light how little they actually tell the people.  Additionally, it made me wonder about what goes on behind closed doors.  If an epidemic of this scale were to occur, would certain people be given priority to treatment just because they are related to a government or health official?  Also, what information would the government keep from the public and would this information be withheld to keep a good public image or in hopes of keeping the people calm?  I hope that if such an epidemic were to occur that our public health infrastructure would respond just as quickly, but that the public were kept more informed.

In this movie, we watched the outbreak of a virus.  An outbreak is when a disease occurs with much higher frequency than would normally be expected.  When an outbreak occurs, public health begins an outbreak investigation.  An outbreak investigation involves many factors.  Some important factors include defining the characteristics of the disease, mapping the spread of the disease, and develop and implement control and prevention systems.  Some control methods include isolation and quarantining.  Isolation is the practice of taking a sick individual and taking them away from the public.  This keeps them from spreading the disease further.  Quarantines can be used to keep healthy people away from those that have contracted the disease, but also can be used to keep people that are suspected of having the disease in a controlled environment.

There were at least three instances in the movie where I thought that the government could have been more prepared.  The first thing I found problematic was the government’s lack of proper public communication.  I feel the government should be better prepared to deal with these situations and be more open with the public to decrease widespread panic.  The second thing I noticed was the lack of food supply.  While I understand that the government may not have huge stocks of food sitting around to give out, I hope that they would be prepared to have at least enough to deal with widespread food shortages.  Finally, I know that staffing of hospitals can become an issue, especially like in this movie where nurses went on strike.  I hope that the government has plans set up to counteract such a situation and make that proper healthcare is available to all that need it in an epidemic.

Climatic Health

Climate change is a growing issue the world over.  In some way, the people of this planet must become more active in dealing with global warming and other related problems.  In some ways, public health can help with this cause and begin to put a spark under our society.

The climate and weather are intimately associated with our health, sometimes in ways we may not think.  For instance, being from a low coastal area, I have witnessed the power of extreme storms such as hurricanes.  With climate change, the possibility of more intense storms continues to rise.  I personally find this terrifying.  We have all seen the power of these storms with the tragedy that was Hurricane Katrina.  Imagining that happening either more often or at a higher intensity really shakes me up with fear.  We could see more casualties than our response forces are ready to deal with.  Additionally, coming from an area where humidity is high, I have seen the effects of heat waves and heat stress.  In fact, during band practice over the summer, I would see approximately five people pass out from heat exhaustion a month.  If the globe continues to get hotter, we can only expect to see more of this, leading to more medical issues such as constant dehydration.  One climate and public health issue that people may not generally think about is the affect climate has on our mental health.  After Hurricane Katrina, we saw a nation shocked and people ripped from their homes.  To have nowhere to turn and no hope, your mind begins to lose stability.  An unstable mind only leads to further health problems.

How can we begin to stop this climate change and increase in health hazards?   Two strategies come to play here mitigation and adaptation.  Mitigation is more of a proactive strategy, involving efforts to decelerate climate change or stop it altogether.  Adaptation is more of preparation to be positively reactive, involving efforts to determine problems before they arise and have plans to deal with the problems. 

Public health can work through these two strategies, mainly working in the realm of adaptation though, in many ways to help people with their health in this time of overwhelming climate change. In fact, one of the most important things the public health officials can do is to inform, educate, and empower people about health issues related to climate change.  Not only is there a great disparity worldwide as to what global climate change is, but also people seem to have no motivation to act because they do not really see the issue developing.  While the changes in climate may be slow, they do add up and if we do not convince people of this soon, it may be too late. 

In my hometown, there does not seem to be too many practices being put into place to deal with climate change.  I have seen them giving hot weather advisories.  Also, I do see more efforts to create public transportation to decrease the amount of emissions.  I believe that a good way to deal with climate change would be to encourage people to practice positive climate practices, such as riding a bike or completely eliminating the use of aerosols.  Certainly, some practice needs to be put into place before it is too late.

Successful Public Health

The world around us is changing.  As it changes, so too must changes to our public health goals and targets occur.  Every decade the CDC puts together a list of the ten greatest public health achievements of the past ten years, showcasing how public health has advanced to conquer new and old problems.  This report focused on the years of 2001-2010. 

The first major achievement was the work against vaccine-preventable diseases, where the introduction of pneumococcal conjugate vaccine and rotavirus were the biggest successes.  Next up was the prevention and control of infectious diseases.  For example, many strides have been made in catching contaminated food products early.  For tobacco, there has been a slowing decline in use.  Many advances have been made for maternal and infant health, such as technological improvements for newborn screening.  Continued efforts are being made in the field of motor vehicle safety.  Cardiovascular disease and cancer prevention have also seen great improvements over the decade.  Much progress was made for workplace safety and worker care.  The war against lead has caused declines in lead poisoning nationwide.  Finally, given the many terrorist events, natural disasters, and disease breakouts, the public health infrastructure has been radically revamped to be more prepared and proactive.

I enjoyed the article, finding it very informative.  However, I do find myself skeptical of a few statistics, mainly those saying something like “rates declined from 2002-2006”.  I found myself asking, well what happened after 2006?  Is there still a decline or are things actually taking a turn for the worse and the incidence of the problem is rising?  It just seems odd to me that they would not show statistics all the way through to 2010.  Of course, this may just be because of lack of information, but my skepticism still remains.

The two problems that I found to be most interesting were tobacco use and vehicle safety.  While I do have emotional ties to both issues, having lost my grandmother to lung cancer and having gone through a severe car accident myself, my reasons for taking a lot from these two issues stems from something else entirely.  I find these issues to be a little silly because they are so preventable, deriving mostly from human error and poor choices.  In fact, I find it odd that smoking is still such a large problem, but know this has a lot to do with money and lobbyist.  As for cars, I realize that no matter how much public health does, vehicles will always be dangerous because the people behind the wheels make mistakes and poor choices.

An issue that I would like to see in the next issue of the CDC public health report would be the obesity epidemic.  The problem here is that across the country more and more people are passing the obesity mark on the BMI scale.  This problem is again mostly preventable by human choice.  I think we are already on the right track with strong advocacy for the issue and changes in eating habits, such as more organic foods.  A big problem, though, is that fast food is more convenient and sometimes cheaper than eating nutritious food from the market.  One way then to possibly attack the obesity epidemic would be to put a higher tax on fast food.  Of course, there are many ways to deal with this and I hope to see new practices put into place in the following years.

Health and Care: A Change for the Better

U.S. Health Care: The Good News displayed the positive moves being made for healthcare in America.  Traveling to different cities around the country, we witnessed new policies and tactics being used that have helped to create a more cost-affective, affordable healthcare of a higher caliber.

Most of what we know about disparities in health services provided across the country comes from a statistical report known as the Dartmouth Atlas.  The atlas began as a simple comparative study between two cities in New England.  When the extreme differences between these two cities became apparent, they knew they needed to expand and study more parts of the country.  Now, the Dartmouth Atlas provides information for the entire nation, pulling its statistics from Medicare data.  What the atlas has helped to show is that there is a great difference in the quality and cost of healthcare across America.  This knowledge has lead change across the country in many different towns.

The first town discussed in the video, Grand Junction, Colorado, has been noted as one of the best cities for healthcare in America.  They had two ideas that really struck me.  First, everyone pays the same for healthcare.  It is silly to think this is a novel idea, but I am glad to hear someone has done it.  Second, doctors are punished for providing expensive or poor health services to their patients.

Next, we traveled to Seattle, Washington, a place proving that big cities can implement better healthcare practices as well.  Here they have a novel idea that I found fascinating and genious – spend more time with patients to get a full idea of all of their ailments.  If you can catch them now and treat them all, the patient will have fewer doctor visits in the long run.  It also brings the treating a human side back to medicine.

In Everett, Washington they created forms that doctors have to fill out before being allowed to use certain medical devices or services.  This showed a 30% decrease in the use of these devices and this decrease probably accounts for times at which the test was not necessary.

Finally, Dartmouth Hospital has attempted to bring patients into the decision making process, which is honestly the way it should be.  It is their life so they should have a say.

I certainly think that all of these practices could and should be implemented in my area.  If it can be done at one place, then it can be done somewhere else with maybe a few minor tweaks to fit social differences.  I find no reason to believe that these practices should not be pursued nationwide.  I think it has not been done, though, because to many healthcare has become a profitable business venture. Some will say, for instance, that doctors will not all agree to the system set up in Grand Junction because they would be making less money.  At some point though, people need to think back and remember that healthcare is exactly that providing health and caring. 

As may already be apparent, I find that access to healthcare is a human right.  As with the doctors at Dartmouth, I think everyone should be given the chance to make a choice.  If they do not want the service then that is your choice.  It is wrong for the government to make that decision for them.

The Vaccine War

As I watched this Frontline special on vaccines, I couldn't help but feel a small sense of frustration.  Perhaps this is because of my biased opinion toward vaccinations.  The special discussed how across the nation people have begun a fight against immunization.  They showed both sides of the argument.  The first side, the scientists and pediatricians, attempt to show there is no harm in vaccines.  The other side, parents, attempt to show that vaccines cause severe problems such as autism in their children.

In the end, I found myself right where I started before watching the special, in favor of vaccines.  As I said earlier, I found myself frustrated.  My frustration stemmed from an extreme disappointment in the parents of the video.  I certainly understand why they feel the way they do, but their proof is purely anecdotal and not set up by hard facts.  I found myself most bothered by disregard for the proactive strategies of vaccination and for the greater good.

As they said in the video, vaccines not only affect those with the vaccine, but also those without it through herd immunity.  Herd immunity is where people that have not developed immunity to a disease are sheltered by those around them that have.  Essentially, the chances of people around them getting the disease are slim and so then their chances are slim as well.  This is especially important for newborns that cannot receive some immunizations because their immune system has not matured enough.  If a large group of people in a specific area begins to stop getting vaccinations, the chances of a breakout occurring increase and this puts others such as infants in danger.

Many reasons can be given as to why vaccinations might not be given.  Some as discussed earlier stem from the parent’s decision against immunization.  Usually parents make this decision because they cannot see the effects of the vaccine and they have only witnessed from their personal experiences or from those on the internet the “associated” side effects.  Some families might not actually be able to afford the vaccinations because they cannot afford healthcare. Also, there may be cases where the physician does not approve of the vaccination and may try to sway the opinions of the parents.

No matter what, I think that vaccinations should not be a choice.  I think that until most, if not all cases of a disease have been taken care of such as for small pox, then vaccinations are a necessary step in public health.  Vaccinations are not like the choice to exercise or take cold medicine.  Colds rarely have fatalities and exercise increases your likelihood of being healthy, but not doing so does not put you and others at an extremely higher risk of death.  Therefore, I think that government should enforce the use of vaccines.

To help support this cause, as a policy maker I would create a viral ad campaign to fight back against all the viral videos against vaccines.  Additionally, if it is not possible to make it a government mandate to take vaccines, it may be possible to charge extra for not getting the vaccination.