Contagion

Contagion was released in 2011, and its popularity fed off of growing fears that a highly infectious disease might rage through the human population, given how globalized the world has become. It showed how the disease was transmitted, from bat to pig to human, and its travel through the population via topical transmission. An interesting aspect was the response by public health agencies, which the movie focused on a great deal. From a public health perspective, the movie accurately showed this range of and how easily a disease with a short incubation period and high rate of transmission can spread through the world. It began with the first victim and the cinematography effectively accentuated where people touched and coughed on. Also, it showed the amalgam of organizations involved in responding to the crisis – scientists, police, emergency medical technicians, political figures, pharmaceuticals, investigative epidemiologists, the media, and regular laypeople. Essentially, it leaves us with the feeling that no one is protected (well, expect for the people that may be immune, like Matt Damon’s character Mitch Emhoff).

An outbreak occurs when an illness is occurring at a higher rate than it would on average in a certain area, and an outbreak investigation is a series of steps taken to establish the presence of the outbreak, hypothesize about it, understand the outbreak, and hopefully through this increase in knowledge lessens the future severity of it. It is quite scientifically structured. Isolation and quarantine, while they sound like synonyms, actually are different measures taken to control an outbreak. Isolation is used to separate ill people from those who are healthy, while quarantine is used to restrict the movement of people who may have been exposed to a disease to see if they become ill. These concepts were put into play in the movie when authorities were attempting to indentify and control the disease. There were mentions in the news portions of “clusters of outbreaks” which eventually spread and the outbreak investigation in the movie attempted to identify the initial hosts, create a vaccine, and lessen the rate of transmission through campaigns and other measures. Isolation occurred with the road block that the military set up to prevent people from crossing state lines and entering Wisconsin, as well as within homes to prevent transmission. And Emhoff was quarantined in the hospital after his wife and step-son died of the illness, but he was found to be immune.

I would hope that agencies should be better prepared for the response to the looting and lawlessness that took place after the disease began to ravage the world. I understand mass rioting is hard to control, and it is a scary thought that is difficult find a solution to, but that modern response systems would hopefully be better. I read a novel about the yellow fever epidemic in Philadelphia, and the scenes of anarchy reminded me of the way an 18^th century outbreak was described. A more modern approach to such issues would definitely need to be devised.

Also, during the epidemic in the movie, the food distribution was greatly lacking. It is rare that food would need to be distributed on a large scale in the United States, and it is interesting and disconcerting to imagine what kind of a plan is in place if that needed to occur. But in the movie, the agencies were constantly running out of supplies, and the fact that people were left to fend for themselves so much seems hard to believe. Scary to imagine!

Climate Change

Quite often, the scope of coverage about climate change focuses solely on environmental changes. Truth is, the changes are just as detrimental to humans as they are to nature. For this week’s blog assignment, we were asked to address the health effects of climate change. Reading the American Journal of Public Health’s “Climate Change: The Public Health Response” offered insight into the topic. Two health affects that may influence the health of my family and friends would be “winter weather anomalies” and “increased ozone and pollen formation” because these changes could impede on our everyday lives. Slips and falls, as well as motor vehicle accidents, due to ice, snow, and rain affect any population group. And, increased pollination would increase allergy and asthma prevalence, which is something may people I know suffer from. Of the health effects on the list, the one that particularly surprised me was the increase in pollen production. The others are extreme weather changes and have been stressed before by many agencies, but I had yet to hear about the effect that climate change will have on allergies and asthma. Now that I think about it, it makes sense, but I had not previously considered it as a risk.

Primary prevention, attempting to lessen the change at hand, involves mitigation. In the case of climate change, the word includes efforts that have been made to reduce our GHG emissions and resource consumption. This will hopefully help prevent, or at least lessen, some effects that climate change will have on populations because the environmental changes will be reduced. Meanwhile, adaptation falls under the secondary and tertiary prevention efforts. It involves efforts to respond to and prepare for the health burdens associated with climate change. This is the response and treatment side rather than the preventative side, incorporating “public health preparedness”.

Public health professionals are an integral part of helping populations adapt to climate change. One specific example of providing a public health service related to the environmental and climate changes going on as a result of human impact would be working with media outlets to dispel any rumors or doubts about climate change, advertising possible effects, and suggesting behavior changes to both lessen environmental impact and health risks. This would be a part of both mitigation and adaptation techniques associated with “informing, educating, and empowering people about health issues.”

My hometown, Princeton, New Jersey, is home to a world-renowned university that is conducting research on climate change and its effect on the human population. Unfortunately, it does not disseminate into the town. I feel as though there is a general sentiment that the effects as so gradual – what does one or two degrees matter? – that they do not need to be addressed. Any small changes have potentially extreme results, while it may not be directly noticeable in my own town. Meanwhile, while Princeton is not necessarily preparing for climate change, they are prepared for emergency response, as should any town that runs smoothly. However, the underlying cause – climate change – still needs to be addressed so that its effects may be turned around. I could spectate a town hall meeting and work to get the issue on the council’s agenda or rally through more of a grass-roots advocacy approach. However, I remain pessimistic that the public will view climate change’s effect on health as a time-sensitive and urgent topic.

Public Health Achievements of the Past Decade

The title of the CDC report, Ten Great Public Health Achievements --- United States, 2001—2010, explains its purpose quite clearly. It highlights the most noteworthy public health achievements that have occurred over the past decade. Reading the list, I see that many interventions I would have thought should be included were indeed incorporated. It is an accurate list, but it is interesting that many of these innovations are not exactly new ideas – for example, motor vehicle safety has been an advocated for and important problem for longer than just this decade. Rather, pressure on such issues had lead to vast further improvements. Therefore, these achievements are not completely accomplished – as long as there are still existing cases, further changes can be made to improve effectiveness and extend lives even more.

The first achievement that particularly resonated with me is the improvement in “public health preparedness and response.” Public Health entities have definitely improved their preparedness and responsiveness over the past decade given the terrorism threats, natural disasters, and epidemics our country has faced. For example, the 2001 anthrax attacks, Hurricane Katrina, E. Coli outbreaks, and the H1N1 virus of the past ten years had really struck a chord with the American public and its policy makers. I remember the fear surrounding all of these events, and am happy that improvements have been made in preparedness to lessen the effects of such situations on the health of populations.

Secondly, the “childhood lead poisoning prevention” achievement resonates with me because lead poisoning is something that has plagued the Baltimore for a very long time, and it particularly affects “black children and those living in poverty and in old, poorly maintained housing.” Last semester, I learned in a class entitled Baltimore & the Wire that there are many old row houses with lead paint and piping, and lead exposure causes possible brain damage in children. The city has been doing a good job of fixing up or knocking down old houses, as well as imposing building regulations to prevent such materials from being used in currently constructed houses. Nationwide, according the article, from 1976-1980 to 2003-2008 the percentage of children with blood lead levels greater than 10 µg/dL showed a declined from 88.2% to 0.9%. This is an amazing achievement that is especially relevant to the health of the city our University is located in, and affects the lives of many.

When the CDC publishes an article in 2020 highlighting the public health achievements of the past decade, I would like to see a significant decrease in the prevalence of antibiotic-resistant strains of existing diseases, for example tuberculosis. This can be accomplished by making sure that patients are treated completely for the illness and complete their treatment regimen rather than stopping treatment because the symptoms diminish. Not only does the disease have a possibility of surging up again, but it has a high chance of being resistant to the antibiotics that were used to treat it the first time. Also, quarantining such a patient is a must. Antibiotics are not being developed fast enough to cope with the increases in antibiotic-resistant diseases. Some officials fear a future epidemic of mutated diseases that are antibiotic-resistant, and this fear can be dissolved by increasing pressure to improve the administration of, and cut down on the abuse of, antibiotics.

The Efficiency of Local U.S. Health Care Systems

A huge question facing politics in our nation is why the United States’ health expenditures are the highest in the world, but the system has been deemed one of the worst. US Health Care: The Good News focuses on successful health systems around the United States that endeavor to achieve both fiscal and physical health. It is based on the findings of the Dartmouth Atlas Project, which tracks differences in health care and spending among American communities, and recognizes certain successful local models that other communities could learn from to achieve the best care systems possible.

The United States was founded under the primary goal of allowing its citizens “life, liberty, and the pursuit of happiness.” While the right to health care is not exactly an amendment in the constitution, but it is a right that should be recognized as part of its citizens leading a healthy and productive life. With an estimated 30% of the current system’s expenditures deemed unnecessary, achieving universal health care is difficult. A restructuring based upon successful programs needs to be accomplished before this right can be realized. At the moment, being provided necessary health care is considered a privilege based on insurance coverage. This does not need to be the case.

The first program highlighted was that of Grand Junction, Colorado, where the doctors have achieved high quality care at low medical cost. The town has in place an independent practice association, where the group of practices blends together earnings and distributes it so that, whether Medicaid or private insurance is being used, the returns balance out. This has allowed a feasible expansion of access. The key innovation here appears to be strong physician leadership. Two systems in Washington State were featured – Seattle and Everett. Seattle’s cooperative group of 300 doctors has proven highly effective. An interesting innovation is that emailing their patients is part of the doctors’ jobs. While other types of businesses have resorted to technology long ago, the medical field is just jumping on. Electronic medical records reduce costs and expand patient-doctor communication as an effective use of time and resources. Meanwhile, an intriguing aspect of Everett’s system is the idea of a nurse care manager – an employee whose role is to work with patients as a counselor so that they may find the most cost- and health-effective treatment for their particular condition. Finally, the Medical Center in Lebanon, New Hampshire emphasizes the importance of a patient’s awareness of their treatment possibilities. This has appeared to be extremely effective in eliminated unnecessary procedures based on a patient’s own informed consent. Improving doctor-patient communication is vital to solving the fiscal issues of the U.S. health system.

These innovative systems are certainly doable. The problem in my community, as in others, is it takes a shift from traditional, profit-driven systems to make way for new ways of thinking. It will be difficult to change the way that the system is run, but it is certainly possible. The first step, for example, would be to have electronic medical records. Putting a certain amount of returns back into the practice to improve efficiency is worth the investment. Health has become a business, and in order for a business to be successful it needs to be competitive and innovative and make changes where needed.