Contagion

While watching the movie Contagion for the first time this week, I was most definitely on the edge of my seat.  I can't imagine a disease so deadly spreading across the globe and science not having the means to stop it or even determine its origin.  The movie did a sufficient job conveying how public health issues are handled from both the political and scientific prospective.  I especially liked the last scene of the movie that revealed the origin of the disease.  

The concepts of outbreak and outbreak investigation are important to public health and relevant to the movie.  An outbreak exists when the number of cases of disease exceeds the expected for a given time, place, or population; it is a sudden rise in the incidence of disease.  In the movie, the outbreak was a result of humans consuming an infected food.  The disease was highly contagious with a short period between contraction of the disease and death.  Once the outbreak was known, public health officials began an outbreak investigation starting with confirming the existence of the outbreak, defining and identifying cases and populations at risk, and eventually evaluating a hypothesis and beginning control and prevention measures.  In the movie, the public health officials realized that the disease did not target any specific group; every person was equally likely to become exposed once it started to spread.  However, scientists could not create a vaccine for the disease before lives were lost on a grand scale.  Isolation and quarantine are also important concepts.  Isolation separates people from other people to prevent the spread of infection.  Isolation is used for people who have already been sick from the disease.  In the movie, the sick were often isolated socially as more and more people became sick; nurses and doctors did not want to help at the risk of contracting the highly contagious, untreatable disease themselves.  Quarantine, however, is for people who have probably been exposed, but are not yet sick.  In the movie, the man who lost his wife and son had probably been exposed and there is a scene that shows him being quarantined.  

On another note, a major sector of public health is preparedness.  In his lecture on public health preparedness and disaster management, Dr. Barnett stressed epidemiological investigations and surveillance as a means for preparedness.  He mentioned that in Maryland - and many other states - it is required by law that a physician must report certain diseases to the local health department.  The only problem with this measure, however, is that many diseases are unreported.  In the movie, it was evident that at first that the disease was unreported because the first symptoms were similar to the common flu.  Also, there were a few situations in the movie where public health agencies could have been better prepared.  There was a scene where the father mentioned before and his daughter attempted to get food being distributed by the army.  It was evident that the distribution was chaotic and ineffective when they ended up not being able to obtain any food.  Public health agencies also could have been better prepared on the political front.  For awhile, doctors were faced with prophet versus profit accusations.  

      

Climate Change: The Public Health Response

Global climate change has become one of the more recent public health issues in society.  When it comes to climate change, effects on human health spread far and wide.  There are different regional and population variations and complexity issues that make it such a threat.  Humans are at increased risk directly for injury by severe weather, heat exposure, and food and water-borne illnesses.

Table 1 depicts weather events and their health effects.  Two events that may directly affect my friends and family include heat waves and increased ozone pollen formation.  Living in the Ohio River valley region of Kentucky, heat waves and pollen can be a dangerous problem.  My family has bad allergies, so high pollen directly effects our attitudes and motivations to be active.  Increased pollen formation and heat waves are two of the contributing factors to my own development of asthma as a sophomore in high school.  As an athlete, this effected my performance.  Also, in past summers, my high school field hockey team could not practice sometimes as a result of intense heat waves.  One thing in the table I had not thought about before was climate change affecting mental health.  It was mentioned in the article that there is not much data on this effect at present, but I am interested to hear if there is a true correlation.

In terms of climate change, mitigation suggests reducing greenhouse gas emission through structures like energy companies, transportation, and architecture.  The idea of mitigation corresponds to primary prevention, which aims to prevent onset of injury or illnesses through means such as immunizations.  On the other hand, adaptation is a concept homologous to secondary and tertiary prevention, which aim to diagnose disease early to control its advance and reduce morbidity after the disease is diagnosed.  Adaptation is different from mitigation in that it aims to anticipate the effects of climate change and reduce the associated health burden through more conventional medical and public health practices.

Most of the article focused on the ten essential public health services that can provide the framework for climate change adaptation and other public health issues.  One specific example of how public health professionals help people adapt to climate change is through the mobilization of community partnerships and action to identify and solve health problems.  For example, collaborations between architects, city planners, transportation cabinets, and even the faith community all work toward this goal.  I found the impact of faith communities particularly interesting because this partnership did not readily come to mind; however, I understand how they would be an effective tool.  By working with faith communities, public health advocates can more effectively disseminate information about how to maintain a 'greener' community.

My home town, and cities all across the country, are taking measures to respond to global climate change.  In 2005, the mayor of Louisville, Kentucky signed the US Conference of Mayor's Climate Protection Agreement, which obligated our city to take measures to reduce our communities greenhouse gases.  Since then, the Climate Change Committee has aggregated and organized a more intricate process for reducing the issue climate change.  Some of the things I do to help mitigate or adapt to climate change is unplug electronics when not in use, conserving water, and using water bottles rather than plastic bottles.  I encourage my friends and people around me to do the same.

Greatest Public Health Achievements

This week's assignment focused on the achievements our country has made on the public health front, specifically within the past decade.  The article was very informative.    It provided statistics to show improvement in several areas.  I found the article a little boring because it was basically just a list, but it presented the achievements in a clear, concise manner.  Most public health articles are concerned with what still needs to be fixed, so it was refreshing to see a paper that reflected on the positive outcomes of what we have already accomplished.  The world is a lot safer and healthier now, not because of health care, but because health advocates have changed the structures of the world to make it a healthier and safer place.

Two of the achievements from the list that particularly resonate with me are tobacco control and motor vehicle safety.  Tobacco use has been very prevalent in my home town in Kentucky in the past.  I have witnessed first-hand the effects of smoke-free laws and tax increases on tobacco products.  As an asthmatic, second-hand smoke can make me feel incredibly uncomfortable and even spark an attack.  Smoke-free laws in restaurants have made it easier for me to go out without worrying about having my inhaler by my side.  Also, many of my friends in high school used tobacco products.  However, when prices began to increase, less and less people continued to smoke.  Not only do I see this as an achievement for tobacco control, but tax like these are also preventing young people like my friends from developing health problems, like lung or mouth cancer, later in life.  Tobacco-use is still an issue in towns like mine across the country, however, the obvious improvements point toward a positive direction.

Achievements in motor vehicle safety also resonates with me personally.  The development of the seat belt and other safety features make the roadways safer and have saved thousands of lives.  Unfortunately, I've already seen some of my own friends die or become seriously injured in accident related deaths, usually as a result of not wearing seat belts.  While motor vehicles themselves have become much safer, enforcement of these safety features must be more strongly emphasized.  Newer cars use negative reinforcement by making an obnoxious beeping sound until the driver and passenger put on their seat belts.  

One public health problem that is not stressed enough currently is the issue of obesity.  Obesity is a major public health issue because it leads to costly health complications--like diabetes or high blood pressure--that are usually otherwise preventable.  Small improvements have begun, but I think it must be treated more aggressively in upcoming years to be considered an achievement by 2020.  For instance, by the time I graduated high school, soda was no longer available in vending machines.  Because our only options were water or other juices, students drank less soda.  Also, some fast food restaurants like Chipotle have added calorie counts to their menus, so that customers are aware how much they are consuming.  I think an effective way to combat obesity is to focus on the younger generations.  If we encourage kids to exercise on a regular basis, they will be more likely to make the choice to stay fit later in life.  
 

Good News in Health Care

Today in the US, health care is a hot--and political--topic.  The documentary "US Health Care: The Good News" examines the most efficient health care systems across the nation, and discusses what makes these medical systems so successful.

The documentary focused on one specific study called the Dartmouth Atlas Project.  The project studied Medicare billing records across the nation and found an explanation for the vast variation across American medicine that could not be explained based upon financial or economical differences between patients.  They found that in most areas, there are no clear rules about how much medical care is the right amount, and some towns spent money on unnecessary procedures.  In one town,  three out of four children had their tonsils removed, and in another only one out of four did, but both towns had the same health outcomes.  The study also found that when there is more equipment or doctors, there will be more procedures and more doctors visits.  I found the Dartmouth Atlas Project intriguing, and I was surprised how often unnecessary procedures are performed.

Another debated topic is whether or not access to health care should be right or a privilege.  In the US it is currently a privilege to have health care, but many believe it is a right.  I think that in the perfect world health care could be a right, but in reality we as a country cannot guarantee it in the near future.  Hopefully one day this issue can be resolved.

The documentary featured several cities that used innovative techniques to make their medical systems successful: Grand Junction, Colorado; Seattle, Washington; Everett, Washington; and at Dartmouth College in New Hampshire.  Grand Junction has an average family income overall, but sources tell us they have the best medical system around.  Not only did I find their system interesting, but I was also intrigued that the entire medical community was on board with it.  Everyone pays the same fee for the same care regardless of which system the patient is in and independent medical practices work together to control costs, which makes it possible to recognize over-utilization.  They withhold part of each payment, which is then distributed at the end of the year based on how well doctors did on target costs and measures.  In Seattle, the median income is slightly higher than the national average.  Their success is based on what they call a patient centered medical home.  In this system, the whole medical team is responsible for every patient leading to greater patient interaction.  Like Seattle, Everett used modern technology to save money.  They have electronic medical records and eliminated pharmaceutical representatives and samples.  Near Dartmouth, the Hitchcock Medical Center focuses on patient involvement in treatment choices.  Letting patients have more voice has led to less surgeries being performed, making the system more successful.

Important lessons can be taken from the medical systems mentioned in the documentary, and I think the way medical care is delivered can be replicated in others cities, including my own.  However, strong community leadership and commitment is necessary for these programs to work, and not every city has that.  Doctors, hospitals, and insurance companies must be collaborative to guarantee the success of such systems, and American health care as a whole has not reached this point.