Public Health at Work Today
Handgun control is an important public health issue. Firearms consistently are the primary cause of injuries and homicides in the United States. In 2005, over 30,000 Americans died of firearm related injuries. In 1994, treatment of gunshot injuries in the US was estimated at $2.3 billion in lifetime medical costs and this cost is rising steadily. Firearms are also responsible for the main cause of violence-related injury deaths, which is suicide.
Public health professionals work to lessen injury and death by firearms by:
CDC, Morbidity and Mortality Weekly; US Department of Education Handgun Epidemic Lowering Plan (HELP) Network; Harvard Public Health Review, Summer 2002; National Center for Injury Prevention and Control, CDC
Smallpox is an acute contagious disease caused by variola virus that originated over 3,000 years ago. For centuries, it caused repeated epidemics that swept across continents, decimated populations, changed thecourse of history and killed as many as 30% of those infected. Between 65-80% of the survivors were marked with deep pitted scars, most prominent on the face. In 1798, it was discovered that an inoculation with cowpox to protect against smallpox brought the first hope that the disease could be controlled. It was not until the 1960's that the World Health Organization launched an intensified plan to eradicate smallpox. It was declared globally eradicated in 1980; however, there are concerns that samples of the smallpox virus that still exist could be used for bioterrorism.
WHO Fact Sheet on Smallpox, October 2001; CDC's Smallpox Preparation and Response Activities; United States Department of Health and Human Services; Modern Healthcare, March 31, 2003
Methicilllin-resistant Staphylococcus aureus (MRSA) infection is caused by staphylococcus aureus bacteria — often called "staph." Decades ago, a strain of staph emerged in hospitals that was resistant to the broad-spectrum antibiotics commonly used to treat it. MRSA was one of the first germs to outwit all but the most powerful drugs.
Staph bacteria are normally found on the skin or in the nose of about one-third of the population. Those who have staph on their skin or in their noses, but aren't sick, are said to be "colonized," not infected with MRSA. Healthy people can be colonized with MRSA and have no ill effects, however, they can pass the germ to others.
Staph bacteria are generally harmless unless they enter the body through a cut or other wound, and even then they often cause only minor skin problems in healthy people. However, in older adults and people who are ill or have weakened immune systems, ordinary staph infections can cause serious illness.
In the 1990s, a type of MRSA began showing up in the wider community. Today, that form of staph, known as community-associated MRSA or CA-MRSA, is responsible for many serious skin and soft tissue infections and for a serious form of pneumonia. When not treated properly, MRSA infection can be fatal.
Vancomycin is one of the few antibiotics still effective against hospital strains of MRSA infection, although the drug is no longer effective in every case. Several drugs continue to work against CA-MRSA, but CA-MRSA is a rapidly evolving bacterium. It may only be a matter of time before it, too, becomes resistant to most antibiotics.
Mayo Clinic, 2007
The spread of the West Nile virus in the United States is a major health concern; since the first reported case in New York in 1999, the mosquito-borne disease has spread across the country. West Nile Encephalitis is an inflammation of the brain and can be caused by viruses and bacteria, including viruses transmitted by mosquito bites Discovered in Uganda in 1937; in 1999, it spread to NYC and caused largest outbreak in US history - 62 cases, seven deaths; as of 2001 it had claimed 21 more human cases and 1 fatality in New York City; by the end of the same year, the virus spread to 28 states with 55 additional confirmed human cases.
In order to prevent outbreaks, the public health community is using geographic information systems (GIS) to track areas where traps catch mosquitoes carrying the virus, and allow the Health Department to go after the larvae in those areas to reduce the spread of the virus. The public is also advised to stay indoors at dawn, dusk, and in the early evening, wear long-sleeved shirts and long pants when outdoors, spray clothing with repellents containing permethrin or DEET, apply insect repellent sparingly to exposed skin, install or repair window and door screens so that mosquitoes cannot get indoors.
Video: West Nile Update (CDC, 2002)
For more information on West Nile Virus, please visit: http://www.cdc.gov/ncidod/dvbid/westnile/index.htm
Centers for Disease Control and Prevention
Chagas disease is caused by the parasite Trypanosoma cruzi, which is transmitted to animals and humans by reduviid bugs, a particular type of insect found only in the Americas. Chagas is more deadly than any other parasitic disease in the Americas (including malaria), causing roughly 50,000 deaths each year. An estimated 16-18 million Latin-Americans are infected with Chagas, most of whom have no idea they are carriers of the disease.
The blood-feeding insect vectors of Chagas disease prefer humid, woodland habitats that are home to their preferred wild mammal and accidental human reservoir hosts. Such habitats are often found within suburban communities today. Originally confined only to Latin America, T. cruzi now infects 20-60% of wild mammals in US urban ecosystems. Since 1955, human cases of locally transmitted, imported and organ transplant-related Chagas disease have been increasing significantly in the US.
Global warming and large-scale population movements from rural to urban areas of Latin America and other regions of the world have increased the geographic distribution of Chagas disease. A migration of armadillos, opossums, raccoons and rodents into forested suburban areas has expanded domestic wild animal reservoirs for Chagas disease; and outdoor-kenneled dogs are now the major domestic animal reservoirs of Chagas disease.
Unlike polio and smallpox, Chagas disease cannot be easily eradicated for many reasons, including an army of insect vectors, large animal reservoirs, difficulties in creating a vaccine, prolonged human asymptomatic stages, exceedingly toxic preventative drugs and poor methods of disease screening.
Only an understanding of the urban development of Chagas disease in the US will direct the proper steps to control and to prevent emerging T. cruzi infections, such as rapid blood screening, early diagnosis and treatment of domestic animal and human infections, better home construction and insulation, respect for the natural cycle of the parasite and household control of carrier insects with safe insecticides to disrupt the urban cycle of disease.
Powerpoint: The New Urban Habitat for Chagas Disease (Diaz, Claiborne, Nieto, et. al., 2007)
Diaz J, Claiborne C, Nieto P, Mischler P, Dorn P, Malone J, Louisiana State University, Schools of Veterinary Medicine and Public Health, 2007
A pandemic is a global disease outbreak. A flu pandemic occurs when a new influenza virus emerges for which people have little or no immunity and for which there is no vaccine. The disease spreads easily person-to-person, causes serious illness and can sweep across the country and around the world in very short time.
Avian (bird) flu is caused by influenza A avian viruses that occur naturally among birds. There are many different subtypes of type A influenza viruses. The avian flu currently of concern is the H5N1 subtype. Wild birds worldwide carry avian influenza viruses in their intestines, but usually do not get sick from them. However, avian influenza is very contagious among birds and can make some domesticated birds (including chickens, ducks and turkeys) very sick and can be fatal.
The risk from avian influenza is generally low to most people, because the viruses do not usually infect humans. However, confirmed cases of human infection from several subtypes of avian influenza infection, including H5N1, have been reported since 1997. Most cases of avian influenza infection in humans have resulted from contact with infected poultry (e.g., domesticated chickens, ducks and turkeys) or surfaces contaminated with secretion/excretions from infected birds.
Symptoms of avian influenza in humans have ranged from typical human influenza-like symptoms (e.g., fever, cough, sore throat, and muscle aches) to eye infections, pneumonia, severe respiratory diseases (such as acute respiratory distress) and other severe and life-threatening complications. The symptoms of avian influenza may depend on which virus caused the infection.
Currently there is no vaccine because a pandemic vaccine cannot be produced until a new pandemic influenza virus emerges and is identified. Even after a pandemic influenza virus has been identified, it could take at least 6 months to develop, test and produce a vaccine.
The US has been working closely with other countries and the World Health Organization to strengthen systems to detect outbreaks of influenza that might cause a pandemic. The Department of Health and Human Services and other federal agencies are providing funding, advice and other support to states to assist with pandemic planning and preparation.
For more information please visit: http://www.pandemicflu.gov
US Department of Health and Human Services, Pandemic Flu Website, March 2006
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Annually, there are people in laboratories racing against time to develop a cheap and effective vaccine against influenza, commonly called the flu. The National Vaccine Program Office is responsible for coordinating and ensuring collaboration among the many federal agencies involved in vaccine and immunization activities.
In the United States, influenza causes an annual average of 36,000 deaths, ranking 7th among all causes of death. The public health laboratory technicians, researchers and administrators that make decisions for vaccine distribution all work together to prevent flu disease and death. Gauging the severity of each flu season's possible flu strains and correctly timing the strains' spread among humans is difficult. Possibly more difficult is the challenge to convince those at most risk, namely children and the elderly, to get a flu vaccine each year.
More information is available at: http://www.hhs.gov/nvpo/influenza_vaccines.html
Being overweight or obese increases the risk of many diseases and health conditions, including the following:
WHO further projects that by 2015, approximately 2.3 billion adults will be overweight and more than 700 million will be obese. Once considered problems only in high-income countries, being overweight and obese are now dramatically on the rise in low- and middle-income countries, particularly in urban settings.
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Childhood obesity continues to be of large concern to Americans. Public health officials often promote two ways for children to improve their physical health: consistent exercise and proper diet.
Video: Every 10 Seconds . . . (International Diabetes Foundation, 2006)
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Trans-fats are unsaturated fatty acids formed during hydrogenation of vegetable oils for use in margarines, commercial cooking and manufacturing processes.
While they may enhance the palatability and shelf-life of foods, trans-fats have been shown to increase risk of coronary heart disease, obesity, type-II diabetes, liver dysfunction and infertility.
While disasters such as earthquakes, floods, drought, cyclones and volcanic eruptions may be “natural” in origin, humans are responsible for hazardous material spills, fires, nuclear meltdowns, acts of terrorism, transportation accidents and wars.
Public health intervention is often necessary in such large-scale incidents, as they require a very different skill set than healthcare workers are traditionally accustomed. Public health officials may provide many of the answers to the following disaster-related questions:
The above photo (by Michael Ainsworth, Dallas Morning News) depicts Superdome evacuees arguing as they attempt to line up for a bus trip to the Houston Astrodome on Thursday, September 1, 2005, several days after Hurricane Katrina flooded New Orleans. A building burns in the background.
In the first months of 2010, we experienced two major natural disasters: the devastating earthquakes in Haiti and Chile. The public health workforce plays an integral role in responding to natural disasters, such as earthquakes. They help ensure access to clean water, food, and shelter; assist in providing healthcare services; provide health education; and monitor diseases and injuries, among other services.
(The photo to the right shows faculty from the Loma Linda Unviersity School of Public Health preparing to disinfect a water cistern after the earthquake in Haiti damaged the water distribution systems.)
Additionally, the U.S. Geological Survey reports there are over 500,000 earthquakes each year, or roughly one every minute. While the vast majority of these earthquakes are so small that they may only be detected with a seismograph, a single powerful earthquake has the potential for catastrophic disaster (such as the ones mentioned above). Since 1970, earthquakes have caused over one million deaths, tens of billions of dollars in property damage, and immeasurable human suffering. Despite innumerable hours of research and thousands of theories from leading scientists, earthquakes remain wholly unpredictable entities.
Video: Earthquakes (Source: Federal Emergency Management Agency, 1988)
The destructive paths wrought by Hurricane Katrina in 2005 and, more recently, the cyclone in Burma, have demonstrated the damaging effects extreme weather events can have on vulnerable populations. Current evidence suggests that global climate change is contributing to an increase in the strength and frequency of these events.
Global climate change is thought to result from the excess accumulation of anthropomorphically generated greenhouse gases which causes an increase in global temperatures. Consistent with increases in global temperature are long-term increases in precipitation and intensity of extreme weather events. Such increases may affect the incidence and severity of health outcomes that are sensitive to weather and climate. While climate change will have a global impact, the most severe effects are likely to be concentrated in vulnerable groups and regions.
For example, in coastal regions, global climate change may result in increased flooding and droughts. Flooding has the potential to impact the availability of potable water and increase the number of vectors/pests such as rats, mosquitoes, and ticks. Along with an increase in vectors, there may be an increase in vector-borne diseases such as malaria and microbial infections such as diphtheria and cholera. Droughts can decrease not only potable water but water available for agriculture which may result in reduced crop yields. Reduced crop yields will cause many of the poor to forgo medications or various other amenities to afford food for their families and themselves.
Increased global temperatures are also thought to be associated with increases in the frequency, intensity, and length of heat waves which have led to an increase in heat related mortality. Heat stroke in the elderly, extremely young, and poor is of particular concern with these populations being vulnerable to the effects of heat and more often having limited access to air conditioning or potable water. Increased rates of respiratory illness have also been associated with global climate change with higher rates of asthma and allergies correlating with exposure to airborne pollen and ozone.
In addition to climate related health effects, global climate change may alter the mental health of affected individuals. The mass displacement of populations which no longer have potable water, a steady food supply, or shelter creates mental strife and a fight for survival. If unaddressed, global climate change could produce a mass exodus of underprivileged communities, with an associated increase in mental disorders such as depression and posttraumatic stress disorder (PTSD).
Public health has a critical role to play in developing mitigation and adaptation strategies that address the impacts of climate change. Each of the core areas of public health addresses specific facets in the battle against climate change. Epidemiologists design studies to evaluate possible climate related health outcomes and identify populations that may be disproportionately affected by climate change. Environmental Health Scientists develop processes to mitigate future climate change as well as identify and implement adaptive strategies to reduce the impact of climate change on health outcomes. Behavioral Scientists provide education and community outreach programs that can enhance the effectiveness of climate change adaptation strategies as well focusing on counseling and mental health programs in support of those affected by climate change. Health Services Administrators create a more efficient and effective response to the effects of climate change by coordinating communication between health services. Those working in Health Policy can work towards legislation which will address both climate change and the associated detrimental effects. Finally, biostatisticians provide the critical quantitative support needed to evaluate and validate the strategies to mitigate and adapt to climate change.
There is much work to be done in the fight against global climate change and public health is one the most effective ways in doing so. As global temperatures rise, public health will have a highly influential voice in the fight against climate change. Addressing the problem on the population level through public health and prevention will reduce unneeded hardship, pain, and suffering in the human race.
For more information on global climate change and its effect on our public's health, click on the following links:
Terrorism has been a threat to the United States for many years. American embassies and civilians living abroad have always been targets for terrorists. The April 19, 1995 bombing of the Alfred P. Murrah Building in Oklahoma City was an incident with massive casualities. The September 11, 2001 bombing of the World Trade Center and subsequent incidences of Anthrax contamination are by far the most serious and frightening incidences on record of civilian populations living in the US soil being threatened by terrorist groups.
US intelligence programs report biological weapons have been developed in foreign countries that include not only anthrax, but also small pox, botulism, plague and hemoraggic fever (Ebola). These diseases are all communicable and potentially deadly.
Large-scale violent acts also have public health implications. Aside from the primary injuries of the violent act, there are many residual effects. For example, when a building is damaged, sanitation systems are either compromised or destroyed, releasing contaminants usually treated by the water purification or sewer systems. Debris and damaged sanitation systems mean rodent populations may increase, thus spreading disease. Deadly chemicals, such as frion used in cooling systems, may be released into the air and cause serious health effects on surrounding neighborhoods. Public health professionals have the interdisciplinary expertise to think beyond the initial situation and to assess and prevent longer-term health effects.
Recent events have underscored the need for trained public health professionals, as well as a sound infrastructure. Public health is an interdisciplinary field of study, which means that it takes many different specialties to build a strong public health system. Many disciplines within public health play a key role in an emergency response.
In the aftermath of September 11th, epidemiologists gathered available information to determine the source of the anthrax contamination and assessed methods to prevent it from spreading. Biostatisticians used mathematical methods to statistically confirm the suspicions of the epidemiologists. Environmental Health Scientists focused on assessing the risk of injury and illness from the aftermath of the destruction of ground zero, such as preventing the damaged sewer systems from contaminating water sources of residents of New York City. Health Services Administrators coordinated the interaction of hospitals, emergency services and health departments. Behavioral Scientists applied social science skills in ensuring the availability of counseling services, both on-site and long-term, for those affected by a disaster scenario.
Students in pursuit of a degree in public health can have a real and profound impact on the health of the nation, and a direct connection to those in their community. A degree in public health will enhance one's ability to assist in preventing disasters, preparing for health emergencies and giving aid in times of tragedy. Public health preparedness is a key factor is dealing with bioterrorist and other terrorist acts.
The Centers for Disease Control and Prevention defines a bioterrorism attack as the deliberate release of viruses, bacteria or other germs (agents) used to cause illness or death in people, animals or plants. While these agents are typically found in nature, it is possible that they could be changed to increase their ability to cause disease, make them resistant to current medicines, or to increase their ability to be spread into the environment. Biological agents can be spread through the air, through water or in food.
Terrorists may use biological agents because they can be highly difficult to detect and do not cause illness for several hours to several days. Some bioterrorism agents, such as Ebola, can be spread from person to person and some, like anthrax, cannot.
Bioterrorism agents are separated into three categories—A, B, or C—depending on how easily they can be spread and the severity of illness or death they cause.
Category A: Highest risk to the public and national security because:
Category B: Second highest risk to the public and national security because:
Category C: Third highest priority agents—emerging pathogens that are dangerous because:
Centers for Disease Control and Prevention, 2006.
Video: The History of Bioterrorism (CDC, 1999)
For more information on bioterrorism please visit: http://www.bt.cdc.gov/bioterrorism/
Some hazardous chemicals have been developed by military organizations for use in warfare. Examples are nerve agents, such as sarin and VX; mustards, such as sulfur and nitrogen mustards; and choking agents, such as phosgene. It might be possible for terrorists to get these chemical warfare agents and use them to harm people.
Centers for Disease Control and Prevention, 2006
For more information on chemical emergencies please visit: http://www.bt.cdc.gov/chemical/
Each of us is exposed to radiation daily from natural sources, including the Sun and the Earth. Small traces of radiation are present in food and water. Radiation also is released from man-made sources such as X-ray machines, television sets and microwave ovens.
For more information on Nuclear Emergencies, please visit: http://www.bt.cdc.gov/radiation/
Terrorist use of an RDD—often called “dirty nuke” or “dirty bomb”—is considered far more likely than use of a nuclear explosive device. An RDD combines a conventional explosive device, such as a bomb, with radioactive material.
Nuclear power plants use the heat generated from nuclear fission in a contained environment to convert water to steam, which powers generators to produce electricity. Nuclear power plants operate in most states in the country and produce about 20% of the nation's power. Nearly 3 million Americans live within 10 miles of an operating nuclear power plant.
Although the construction and operation of these facilities are closely monitored and regulated by the Nuclear Regulatory Commission (NRC), accidents are possible. An accident could result in dangerous levels of radiation that could affect the health and safety of the public living near the nuclear power plant.
Chernobyl Meltdown (above left): On April 26,1986 the world witnessed the most serious nuclear accident in history. The Chernobyl disaster was a human tragedy, resulting in large-scale displacement of populations, the contamination of vast areas of land and the loss of livelihoods.
Photo Credit: Anatoly Maltsev, EPA
"...the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being..."
Public health is a field in which the health of the entire population is a goal. As a result, public health officials fight for the health care of all individuals on a daily basis. The elimination of health disparities and treatment of health as a right for everyone is a key part of public health.Every country in the world is now party to at least one human rights treaty that addresses health-related rights. This includes the right to health as well as other rights that relate to conditions necessary for health. The role of the WHO Health and Human Rights Team is to:
Video: My Health, My Right (World Health Organization, 2006)
For more information on Health Equity and Human rights please visit http://www.who.int/hhr/en/
There are an estimated 370 million indigenous people living in over 70 countries worldwide. They present a rich diversity of cultures, religions, traditions, languages and histories, yet they continue to be among the world's poorest and most marginalized populations.
Discrimination on the basis of sex and gender roles – also called gender discrimination – remains pervasive worldwide. There are very few countries where women are equal to men from the point of view of legal, social and economic rights. Additionally, gender gaps are widespread in access to and control over resources, in economic opportunities, in power and political voice.