Sunday, July 6, 2014

Some broad threats to public health

File:Overflowepa.gifA recent Twitter thread highlighted several current threats to public health and I thought the points were sufficiently important to immortalize in a blog -- not necessarily because any one point is of primal importance (although each one alone is stunningly important for public health), but rather because we often forget to think holistically about public health. The reality is, of course, that many areas must combine in order to make good public health possible.

The thread highlighted three elements of public health that are all compromised to some extent at present: the effectiveness of antimicrobial drugs, the coverage of vaccination against vaccine preventable infectious diseases, and the preservation of sanitation infrastructure.

A few words about each of these. The specter of pathogens resistant to current antimicrobial drugs is well known. This topic is widely covered in the news media, in the scientific and medical literature, and even in political discourse. There is also a rich conversation on social media. Much has been written about the coming -- or, if you're a patient infected with a resistant pathogen, the present -- post-antibiotic era. The threat to public health is so great that the issue is now commanding economic and political attention, which hopefully will result in action soon.

And yet, antimicrobial resistance is not the only important threat to public health. The incidence of many vaccine-preventable diseases is increasing, not because pathogens are evolving and becoming mismatched to vaccines, but because significant numbers of people are electing to forgo having children vaccinated. The reasons why are varied and complex, but often they originate in mistrust between people and those who make and provide vaccines. Part of that mistrust was eroded by deeply flawed published research that has since been discredited; meanwhile, the effects and attendant impacts on human health continue. Moreover, vaccines are getting more expensive, and have been for years, which probably doesn't help the goal of increasing coverage, either.

Lastly, the sanitation infrastructure in many US cities is old, undersized, and crumbling. (It's not only the sanitation infrastructure that is failing or threatening to fail; transportation and power distribution are similar stories.) As a result, human waste is frequently released into the environment. This is remarkable for many reasons, not the least of which is that sanitation is one the oldest and most recognized cornerstones of public health. The undesirability of having human excrement handled improperly is so obvious that there's no reason to belabor the point here.

It's tempting to refer to these issues as horsemen of the public health apocalypse, but that would be bombastic and incomplete. There are other important threats, including the safety of the food supply, the high incidence of healthcare associated infections (both susceptible and drug resistant), the growing prominence of chronic diseases of the aging and the attendant demands on healthcare resources, and the continued emergence of new pathogens from nature.

To close, it's good to resurface from the depths of one's own research periodically. It can result in context and perspective, which is badly needed in any field of research. Much has been written about the use of Twitter in healthcare and biomedical research. Maybe this is another: it can force you to come up for air.

(image source: Wikipedia)

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