Ten Great Public Health Achievements of the US; What About Developing Nations?

Today, I’ll be talking about an article in a Center for Disease Control (CDC) publication called Morbidity and Mortality Weekly Report (MMWR) (subscribe here!)  The article is titled “Ten Great Public Health Achievements” and describes ten “notable” public health achievements that occurred during the 1900s in the US.  (However, I want to clearly say that I will not limit this discussion to just public health in the US; I’m going global.)  Anyways, the achievements are:    

• Vaccination
• Motor-vehicle safety 
• Safer workplaces 
• Control of infectious diseases  
• Decline in deaths from coronary heart disease and stroke
• Safer and healthier foods 
• Healthier mothers and babies 
• Family Planning 
• Fluoridation of drinking water 
• Recognition of tobacco use as a health hazard      

Of course, there are many more achievements but the CDC lists these as having the greatest “opportunity for prevention [and] impact on death, illness, and disability in the United States.”    

These are great achievements indeed!  Vaccinations have been extremely successful against diseases such as polio, smallpox and chickenpox; fluoridation of drinking water has greatly augmented our health; and seatbelts have saved countless lives.  But it’s surprising how many of these achievements go without recognition.  To me, that is a sign of success; when you can influence the nation to adopt something into the mainstream culture and have it last long enough without debate…that is a successful policy.  But again, we take so many of them for granted, and we do this even when they aren’t available for the majority of the world (is that really success then? I’ll come back to this.)    

Two of the achievements I find interesting are “control of infectious disease” and “safer and healthier foods.”  Infectious disease control interests me because I enjoy studying the interactions of other microbes/organisms with our body.  Infectious disease is also still extremely relevant in today’s world of vaccines and antimicrobial therapy.  Even though the US has made great advances in reducing infections of TB, STDs and Cholera, this is not so true for all developing countries.  For example, in Haiti and Ghana, TB still has high prevalence despite public health advancements in the US.    

Safe and healthy foods is also an interesting topic because of the recent movement to shed light on issues like factory farming, organic foods and foodborne illnesses.  However, the safe and healthy foods that the article talks about are safe and healthy because of advancements made in adding nutritional content to food and decreasing microbial contamination through sanitation techniques, etc.  (Think about Sinclair’s The Jungle and the establishment of the FDA.)  However, again, in developing nations how effective is food safety, and even more, food security?  This would be an interesting issue to look into.    

I feel like the article missed the Clean Air Act 1963.  The Clean Air Act is important because it allowed for all levels of government to discuss air pollution and to set up research and control programs in order to benefit public health through regulations.  The act is being constantly improved, and we already know that it has been successful.    

All the achievements listed are successful.  So now what I’d like to see is that list become a list of achievements of global health (ensuring the US achievements of 1900s reach the furthest corners of the globe.)  Only then can we claim true success for humanity.

Eric Wan

Are Vaccines and Autism Related?

Today I will be discussing a recent news article about vaccinations and autism.  Also refer to the supplement.

I remember in 2008 reading an article about a British study that linked MMR vaccinations to autism; that study was published back in 1998.  The study caused wide-spread panic in Britain, and significantly decreased the proportion of immunized children.

Since then, the study has been widely discredited (other studies between 1998 and 2004 couldn’t find an association), and the British doctor responsible for the study was banned in 2010 for “professional misconduct” and ethic violations in his study.  However, the effects of his study still exist.

Whether vaccines cause autism is still a debated issue.  On Tuesday, MedicalNewsToday published an article about a study that addresses that exact debate.

The study was conducted on 1,008 vaccinated children and sought to examine any association between exposure to thimerosal (mercury) in vaccines and developing Autism Spectrum Disorder (ASD).  The study is set-up as a case-control study and split the children into two groups: “diagnosed with ASD” and “not having ASD.”  The researchers controlled for factors like age and gender.  Then, the study examined each child’s exposure to thimerosal in vaccines; they assessed exposures by looking at medical records and interviewing families (ensuring that book groups were assessed similarly).

The researchers found no association between thimerosal exposure and developing ASD.  In fact, the article says that the children without ASD generally had higher mercury exposures than children with ASD.  Additionally, the article reports that the study found that in babies, more vaccination with thimerosal-containing vaccines seemed to associate with less likelihood of developing ASD.

Even though the study adds to a growing list of studies that disprove the speculated vaccine-autism link, we have to read the article carefully.  Several questions have to be asked before we can say this study is really adequate.  How did the researchers calculate exposure?  One way would be to determine how much mercury was in each reported vaccine.  What is the odds ratio (OR)?  Without the OR, we cannot come to a conclusion for ourselves.

We also have to examine the weaknesses of any case-control study.  Case-control studies can suffer from biases like recall bias, though this study seemed to take care of that by cross-referencing family interviews with medical records.  Another bias is in the selection of the control and cases groups.  If the groups are not representative of their respective populations, then selection bias could be in play and the study cannot be extrapolated.

However, there are also strengths to a case-control study.  These studies are usually quick, cheap and efficient.  Plus, in comparison with randomized clinical trials, there are less ethical issues.

Regardless of the design and conclusions of this study, the vaccine-autism debate is still a public health issue.  The article reports that “one in every four parents is afraid of vaccinating their children because of a perceived autism risk.”  As long as that perception is still wide spread, the purpose of vaccinations will be undermined.  Therefore, it is important to assess the actual risk (through determining associations) and change perceptions with data.  However, it is still perplexing that such a wide spread fear still exists.  Why? would be an interesting question to answer.

Any speculations?
Eric

An Overview about My Education in Public Health

Welcome to my first ever blog made specifically for a class!  I’m Eric Wan, and this blog will be primarily for discussing public health, under the guidance of my Introduction to Public Health course.

Today, I will talk about why I’m interested in public health, what I’ve learned in class so far, what I hope to get out of this course, and what my interests are in public health.

So, why Introduction to Public Health?   Public Health began to interest me only when I sought to learn more about it.  After my sophomore year in high school, I attended an Epidemiology course at Johns Hopkins’s Center for Talented Youth.  The course taught me a lot about the goals and methods of Epidemiology (I fondly call it “Epi.”)  Little did I know, Epi at CTY would get me hooked into public health.

But something else also happened during high school.  I took an International Human Rights course that showed me several cases of public health inequities (Gaza strip running out of water, for example).  This brought human significance to the field of public health, beyond just goals and methods on paper.

So here I am today, deepening my knowledge about public health in the hope that I can begin to view the world from the perspective of public health.  But to see from the eyes of public health, I had to first understand what public health even is.

Public health is multidisciplinary with its goal to promote and facilitate healthy living.  The CDC puts it as “[promoting] health and quality of life.”  When we dissect the term “public health,” we get two constituent parts (public and health). 

“Public” means that all levels of the government are engaged in promoting peoples’ well-being.  To have “health” requires acceptable environments, good nutrition and good behaviors, etc.  Together, these two constituent parts indicate that for public health to be successful, it requires government participation in ensuring peoples’ health.

A novel idea I learned in class is that public health deals with disparities, and eliminating them.  Dr. Miriam Alexander, a course instructor, told us that health is proportional to wealth (more money equals better health) and that public health is no longer a problem about the lack of treatments, but rather, it is about the problem of not being able to access those treatments. 

After I heard this, I finally understood what was going on in public health; furthermore, I finally understand Dr. Paul Farmer’s books!  Public health is really about eliminating the disparities (socioeconomic, access, education) that prevent destitute populations from getting the healthcare they need.  And governments need to be involved in eliminating disparities.

Insights like this are what make this course so exciting!  I’m hoping this course will change all my preconceptions and inspire me to think cleverly about future public health.

In the future, I hope to study diseases that are important to developing nations.  AIDS is a popular one, but tuberculosis is still an issue, especially extreme-drug-resistant tuberculosis.  I’m also intrigued and perplexed by the disparities that prevent modern medicine from reaching these populations (inequalities that harm health are just not right.)

Stay with me on my public health journey!

Eric Wan