Intro to Public Health - Blog 8

Hey again everyone!

This past week we learned about public health law in class and all had to read a case that falls under that category of law. The suit was brought about by Mary V. Kirk against the Board of Health of the city of Aiken, South Carolina. It was found that Mrs. Kirk was afflicted with leprosy, a very contagious disease. The board of health then passed resolutions requiring her to be isolated in the city hospital for infectious diseases in order to protect the rest of the community. Miss Kirk alleged that the kind of leprosy she had was not contagious and that the conditions of her isolation were too vile for a woman of her “culture and refinement.” After the board was asked to show cause, Miss Kirk was granted a temporary injunction, preventing the board from moving her to the city hospital. They deemed it unnecessary for her to be sent into isolation when her house and property had already been quarantined, which, as far as the courts could see, she did not violate. In order to stop the spread of infectious diseases and protect the general public, public health officials rely on two different strategies: isolation or quarantine. Isolation is for the people who are already ill and must be moved away from the healthy population. Quarantine is the restriction of movement of those who have been exposed to an infectious agent and are putting the healthy population at risk. In the situation of Miss Kirk, the courts believed that her quarantine was effective in protecting the health of the citizens of Aiken.

This type of issue is one that is often brought up in the field of public health. Individual rights versus protection of the community. Individuals, like Mary Kirk, are frequently upset by the restrictions or mandates placed on them by various health boards that are meant to improve the health of the greater community. I think it’s important that we have these boards looking out for the population on a large scale. If after a thorough investigation, the board deems it necessary, I think they definitely have the right to decide if someone should be isolated or quarantined. But the board must be absolutely sure that the community is at high risk. In the case of Miss Kirk, she had a less contagious form of leprosy and the people around her really weren’t in jeopardy. It’s important that the courts exist so that they can make sure the boards aren’t going to far. I think that it’s better if there’s an error on the side of the individual (which the court can fix), rather than an error on the side of the community. This utilitarian approach will protect the most amounts of people.  A state would rather have one sick person rather than an entire sick community, which would cost them astronomical amounts of time and money.

Intro to Public Health - Blog 7

This week we all had to read an article called “The Challenge of Global Health.” The article basically discusses the state of global public health today and the various obstacles and challenges that need to be faced and addressed. In the past few decades or so, there has been an incredible increase in public and private money being donated towards numerous pressing global health issues. You would think this is a good thing but, unfortunately, the efforts that the money is going to are very disorganized. Also, the money is being directed at specific diseases, rather than at general public health. Another huge problem for the developing countries is their shortage of doctors and nurses. Reasons for this include that more and more local talent from developing countries are coming to the more developed countries for work and leaving their countries behind.

I think that this lack of staff is one of the most valid reasons for why public health is worsening in the developing world. The numbers are quite staggering. In Ghana, for example, of the 871 medical officers that were trained between 1993 and 2002, 604 of them now practice overseas. These types of numbers are similar in Zimbabwe, Zambia, Malawi, and many other developing nations. Another factor contributing to the shortage is how large a percentage of the healthcare workers are infected with HIV/AIDS themselves. One study estimates 18-41 percent of the healthcare force in Africa to be infected. The workers are dying faster than they can be treated, triggering the entire system to collapse. What good are the drugs if there is no one to distribute them? But this problem is being addressed! There is now a $270 million plan in place, supported by PEPFAR (President’s Emergency Plan for AIDS Relief), trying to bring back half of the lost health care workers using financial incentives and training.

Another thing that is stressed in the article is that increased maternal survival rates and increased overall life expectancy should be the two main goals of the world health community. Instead of money being funneled into hundreds of different, single diseases, they should be aimed at these two simple goals. The rate of maternal mortality is very telling of the status and efficiency of the overall healthcare system. With clean surgical facilities staffed by enough well trained professionals using sterile equipment, there should be a low maternal mortality rate. Similarly, life expectancy gives an idea of the overall public health services. With safe drinking water, nutritional food, easily accessible immunizations performed with sterile tools, there should be high life expectancy.

While it is great that there has been such a surge in aid and finances, faulty systems and lack of sustainability of funds often lead to the disease states that are worse than originally seen. According to a World Bank report, half of all funds donated for health efforts in Sub-Saharan Africa, such as HIV/AIDS, TB, or malaria, never reach the end of the line. Money is lost along the way to payment of ghost employees, padded prices, selling of drugs to the black market, and the sale of fake medications. There needs to be more oversight and guidance of the massive funds being donated. Another issue is how dependent these underdeveloped countries become on foreign aid. Without proper exit strategies, the entire system could collapse once the wealthier countries transfer control to the underdeveloped nations, helping no one in the process.

This article was super informative and very interesting to read. Global health is and will be one of the greatest challenges for my generation and generations to follow!

Intro to Public Health - Blog 6

This week the entire class was assigned to read an article recently published in the Washington Post entitled “Whooping Cough Makes a Comeback.” While many people may think that whooping cough “is a disease of the past”, it has been becoming more and more prevalent over the past few years. In California alone, nine infants have already died this year while 600 more have become extremely ill. 4,100 cases have been reported in what people are calling the worst outbreak of pertussis in the state’s history since 1955.  The article discusses a couple of possible reasons for the spike in amount of cases. In California, it is much easier than in Maryland, for example, to a parent to refuse vaccination for their child. Although it has been discredited, many parents believe that vaccines can cause autism in their children. The article mentions that in 2009 in Marin County, an affluent county north of San Francisco, 13 percent of kindergarten parents refused vaccination of their children. Marin County is one of the highest infected counties of the year. Another possible cause listed by the article is the vaccine itself. In the mid-90’s the vaccines changed from acellular vaccines to whole-cell vaccines.  The whole-cell vaccines were effective against the cough but causes seizures, high fevers, and have been blamed for rare brain damage. The new vaccine does not always protect from the cough but patients often get lighter versions of the disease. The article does say, although, that increased vaccination is the best way to lower the increased rates of whooping cough. This refers to the public health theory of “herd immunity.” This is when the immunization of a certain amount of the population protects the portion of the population that has not been immunized. The more people that are vaccinated, the lower the chance a susceptible individual will come in contact with someone infected with the disease. While this theory is true to some extent, the more people that rely on this, the larger the portion of the population that does not have the vaccination.

There are a variety of reasons why a child would not receive a vaccine. Two reasons that originate from parents include fear of developing a disease like autism or too high of a reliance on the idea of “herd immunity.” A physician may discourage a vaccination because he or she has never seen it in any of their patients. The article actually mentions a woman who had whooping cough with an infant son and whose doctor told her she didn’t need to wear a mask because “we don’t see it anymore.” Reasons not to get immunized relating back to the healthcare system may be that a family simply can’t afford the shot because they don’t have a healthcare plan. 

Clearly, the priority of public health policymakers should be focused on increasing vaccine rates throughout the country.  In order to get this accomplished, strict restrictions on vaccinations must be made mandatory in every state. But even with these strict rules, parents will still be nervous. One way to deal with that would be to have some sort of database where they could read all the information pertaining to vaccines. Often parents base their fears off of silly rumors without really doing any thorough research. 

Intro to Public Health - Blog 5

Hey everyone!

I’m back again and this week I’m going to be talking a little bit about second-hand smoke and it’s implications. Everyone in our class was required to read about a study done in Japan that helped to determine the relationship between second-hand smoke and lung cancer. It took place over 14 years and was conducted in 29 health center districts in Japan. 91,450 non-smoking wives aged 40 years and older were followed up between 1966 and 1979 and their mortality rates due to lung cancer were measured in relation to the smoking habits of their husbands. It was found that wives of heavy smokers were found to have a higher risk of developing lung cancer. The husbands’ smoking habits did not affect the wives’ risk of dying from other cancers such as stomach or cervical. There was also evidence that the risk of developing emphysema and asthma is increased in non-smoking wives of heavy smokers but the statistics were not significant enough.  This study also compared the effect of passive smoking to direct smoking and found that passive smoking had an effect of one half to one third that of direct smoking.

The type of study is called a cohort study. In a cohort study, large numbers of people are questioned about their lifestyle and various exposures. They are then followed over a period of time to see weather those exposed are more likely to develop a certain disease or diseases. There are many advantages to these types of studies. Some of these include the fact that you have an opportunity to study many possible outcomes from one specific exposure. Another advantage is that both the incidence rate (absolute risk) and the relative risk can be calculated. Also, in this specific study, detailed questions about lifestyle were asked of the husbands and wives independently rather than together. This allowed for no subjective bias to be formed.

Second-hand smoke is definitely an environmental health issue rather than behavioral. In class on Monday, our lecturer, Dr. Jonathan Links, addressed this very issue. He talked about the difference between direct smoking and second hand smoke. Direct smoking would require a behavioral intervention.  But, in order for cigarette smoke in the air to be regulated, an environmental intervention would be needed to stop people from having to breathe in other people’s smoke. From a personal standpoint, it definitely affects me and bothers me when I have to stand next to people who are smoking. The smell can sometimes make me feel extremely nauseous and I’ll often have to move.

I think that the results of this study definitely support the idea that second-hand smoke can be and is a cause of lung cancer. There is a huge amount of evidence showing the relation ship between the two. It was clearly proven in the statistics that the wives of heavy smokers had a higher mortality rate from lung cancer compared to the wives of non-smokers.

I found this week’s assignment to be really interesting and I hope you did too! Until next week!

Intro to Public Health - Blog 4

Hey all!

I’m back again and this week I’m going to be talking a little bit about chronic diseases. This week we were all assigned to read a recently published article titled “Global Noncommunicable Diseases – Where Worlds Meet” from the New England Journal of Medicine. The article discusses the global spread of non-communicable diseases, such as cancer, heart disease, stroke, or diabetes. It says that this spread gives low, middle, and high-income countries a chance to come together in an effort to attack this worldwide threat. Globally, chronic disease accounts for 60% of all deaths with 80% of those deaths occurring in low or middle-income countries.  The article also identifies the top six risk factors connected with noncommunicable diseases to be high blood pressure, tobacco use, high blood glucose levels, physical inactivity, overweight or obesity, and high cholesterol levels. Tackling these diseases can give countries worldwide a common purpose. In closing, the article states that we must engage policymakers and help them see the opportunity that they have to fight this global trend.

In the article, there was a table that showed the top ten risk factors globally, in low-income countries, middle-income countries, and high-income countries. It can be seen on this table that many of the risk factors in the three types of country all overlap. This is not too surprising to me. Bad and risky behavior, such as poor eating habits, lack of exercise, tobacco use, or alcohol abuse, transcends money and income. Not a lot of money is being spent in low-, middle-, or high-income countries on education about the dangers of certain behaviors that lead to the risk factors, which then lead to development of chronic diseases.  

In class this week, we talked about two different chronic diseases: heart disease and diabetes. We discussed the different risk factors associated with the diseases and then the professor illustrated primary, secondary, and tertiary prevention. Primary prevention is when measures are set in place to prevent diseases before the biological onset of the disease. This type of prevention is aimed at everyone. Secondary prevention is the detection of disease in its earliest stages before the symptoms are noticeable. This type of prevention is aimed at people who have a specific risk factor associated with the disease. Finally, tertiary prevention is prevention of disease progression after someone is clinically diagnosed. This prevention is aimed at specifically people who have the disease. One disease that we can look at and talk about the various levels of prevention is HIV/AIDS. Some primary prevention methods for HIV/AIDS may include education of the community about safe sex practices or drug use. An example of secondary prevention could include various counseling programs, social marketing campaigns, or policy interventions. And finally, for tertiary prevention, methods might include better access to medical care. I think that my examples of primary prevention would definitely be achievable in low and middle-income countries but as for the tertiary prevention, it would, unfortunately, most likely only be achievable in high-income countries. This is just more evidence that, globally, we should unite in order to help combat these diseases.

I hope you all found my blog interesting this week! Check back next week for another post!