Hi! This week we were asked to read an important court decision in public health. In this case, a woman suffering from leprosy, Mary Kirk, was fighting the Board of Health's decision to mandate her to move to the contagious division of the city hospital. At this time, the city pest houses were very dirty places. This particular one was also very close to the garbage dump and filled with people infected with small pox. Since Ms. Kirk was a woman of high social standing, the city offered to build her a cottage outside the city where she could live. However, since the cottage would not be ready immediately, the Board of Health requested that Ms. Kirk live in the hospital as temporary housing. Ms. Kirk argued that her leprosy was not a very contagious type and felt that being forced to live in the hospital was a violation of her personal rights. The courts ruled that it was within the powers of the Board of Health to decide what steps are necessary to protect the health of the public. Also, the court ruled that the individual rights to liberty and property do not hold when exercising this right harms others.
First of all, when talking about this case, it is important to make a distinction between quarantine and isolation. Quarantine is used when describing someone that has been (or may have been) exposed to a disease, but does not yet show symptoms. For example, United States immigration officials often quarantine entrants to the country that come from areas with high rates of endemic infectious disease. In this case an immigrant from an area with high malaria rates might be held for a period of time in order to ensure that he or she will not develop malaria and spread it. On the other hand, isolation refers to a person who already has an infectious disease. In this case, although the term quarantine is used, it would probably be more accurate to say that Ms. Kirk was ordered into isolation due to fears that she would cause others to contract the disease she already has (leprosy).
The decision of when an individual should be quarantined is a difficult one. In my opinion, the health department should set guidelines for when a person should be quarantined. These guidelines should be based on research regarding infection rates and virulence of different diseases. It is extremely important that these decisions be made based on scientific evidence. Physicians should be educated on these rules and asked to enforce them. Then, when a physician sees someone that should be quarantined, he or she can inform the patient and take the necessary steps.
While deciding who should be quarantined is a scientific decision, figuring out how to balance individual and community rights is more of an ethical and legal issue. These decisions should be made by the court system. It is the responsibility of the courts to interpret the constitution and decide when allowing an individual to exercise his or her rights violates the public well-being and vice versa. Another difficult decision is whether or not to err on the side of individual or public rights. In this case, I think it is important to do what is best for the most people. Of course, reason must be used to ensure that individual rights are not needlessly violated.
That's it for this week. Bye!
Tuesday, February 23, 2010
Wednesday, February 17, 2010
Sizing up the Competition
This week's assignment is very seasonal. In the spirit of the Olympic Games (GO USA!!!), I will be blogging about an article comparing the US's health care performance to that of the 29 other members of the Organization for Economic Cooperation and Development. As I watch Lindsey Vonn ski for the gold I can only hope our health care system competes nearly as well.
Some measures were not too surprising. The United States spends more on health care and pharmaceuticals, per capita, than any other country. The US spends 16% on healthcare whereas the average of the other countries is about half that. Also, the US has the lowest percentage of population of daily smokers. This is a testament to one of the greatest public health achievements of the last fifty years. In the next fifty years I think the other countries listed will improve on this statistic. Unfortunately, I was not surprised to find that the United States has the highest obesity rate of any of the countries. I think that this public health challenge will be integral in improving US health in the next 50 years.
I was surprised to find that the United States is well below average in doctor consultations per capita. This is especially surprising given the amount of money Americans spend on healthcare. I was also surprised to find that the United States is below average in the number of practicing physicians per 1,000 population. Usually, news reports highlight the shortage of primary care doctors and excess specialists. I was not aware that there is an overall shortage of US doctors.
Two of these measures will have a tremendous impact on the future of American public health. One is the fact that the United States spends the most per capita on health care but the least percentage of government funds. This system is unsustainable and does not lead to health outcomes better than those of other countries that spend significantly less. Health care reform is a very difficult and divisive issue. However, in my opinion, it is a social injustice for the United States to continue to have approximately 15% of the country uninsured. I think that any restructuring of the health care system needs to take into account providing dependable coverage for this group. An interesting part of this debate is that the CDC has not been more involved in lobbying for a system that provides more satisfactory health outcomes.
The obesity epidemic is another factor that is influencing American rate at an increasing rate. Obesity causes heart disease, diabetes, and other serious illnesses. Programs such as the NYC trans fat ban, the decision in many cities to include nutritional info on menus, and interventions aimed at increasing physical activity levels. In my opinion, to be effective, programs need to begin in schools and stress healthy eating and high physical activity levels from a young age. The CDC should make sure that foods offered at school are healthy and balanced and that children are taught the importance of frequent physical activity and proper nutrition habits.
P.S. Lindsey Vonn and Julia Mancuso, both of the US, won gold and silver in the women's downhill!
Some measures were not too surprising. The United States spends more on health care and pharmaceuticals, per capita, than any other country. The US spends 16% on healthcare whereas the average of the other countries is about half that. Also, the US has the lowest percentage of population of daily smokers. This is a testament to one of the greatest public health achievements of the last fifty years. In the next fifty years I think the other countries listed will improve on this statistic. Unfortunately, I was not surprised to find that the United States has the highest obesity rate of any of the countries. I think that this public health challenge will be integral in improving US health in the next 50 years.
I was surprised to find that the United States is well below average in doctor consultations per capita. This is especially surprising given the amount of money Americans spend on healthcare. I was also surprised to find that the United States is below average in the number of practicing physicians per 1,000 population. Usually, news reports highlight the shortage of primary care doctors and excess specialists. I was not aware that there is an overall shortage of US doctors.
Two of these measures will have a tremendous impact on the future of American public health. One is the fact that the United States spends the most per capita on health care but the least percentage of government funds. This system is unsustainable and does not lead to health outcomes better than those of other countries that spend significantly less. Health care reform is a very difficult and divisive issue. However, in my opinion, it is a social injustice for the United States to continue to have approximately 15% of the country uninsured. I think that any restructuring of the health care system needs to take into account providing dependable coverage for this group. An interesting part of this debate is that the CDC has not been more involved in lobbying for a system that provides more satisfactory health outcomes.
The obesity epidemic is another factor that is influencing American rate at an increasing rate. Obesity causes heart disease, diabetes, and other serious illnesses. Programs such as the NYC trans fat ban, the decision in many cities to include nutritional info on menus, and interventions aimed at increasing physical activity levels. In my opinion, to be effective, programs need to begin in schools and stress healthy eating and high physical activity levels from a young age. The CDC should make sure that foods offered at school are healthy and balanced and that children are taught the importance of frequent physical activity and proper nutrition habits.
P.S. Lindsey Vonn and Julia Mancuso, both of the US, won gold and silver in the women's downhill!
Wednesday, February 10, 2010
Top Ten Greatest Public Health Interventions
Hi all,
This week's blog is about the top ten greatest public health interventions of the 1900s. Too bad one of them wasn't an instant snow remover or a fireplace I can use in my apartment. It's the snow-pocalypse out there! Anway, hopefully this blog will keep someone occupied as we wait out the blizzard.
The Top Ten Interventions are:
1. Vaccination
2. Motor Vehicle Safety
3. Safer Workplaces
4. Control of Infectious Diseases
5. Decline in Deaths from Coronary Heart Disease and Stroke
6. Safer and Healthier Foods
7. Healthier Mothers and Babies
8. Family Planning
9. Flouridation of Drinking Water
10. Recognition of Tobacco Use as a Health Hazard
Wow! Public Health sure has accomplished alot in the last century. What really shocked me is that since 1900, average life expectancy has grown by more than 30 years! Public Health is responsible for 25 of those years which is truly a feat to be proud of.
One of the most interesting things about this list is that almost everyone has been effected by most if not all of the interventions. We all benefit from the flouridation of drinking water, healthier foods, and safer workplaces. Also, infant and child mortality declines were helped by maternal health reforms and vaccination campaigns which have eradicated or severely lessened many diseases that were previously devastating. As any high school graduate can tell you, education programs regarding motor vehicle safety and tobacco as a health hazard are unavoidable. Also, when purchasing a new car, we often take for granted the anti-lock brakes, side-impact air bags, and seat belts that have saved so many lives. Next, as a woman, I particularly value the family planning interventions that were integral in both improving women's health and facilitating the women's liberation movement. Finally, since cardiovascular disease is currently the number one killer in the United States, any interventions that reduce the number of people dying from these diseases are important to all Americans.
Today, I will take just two of these interventions and elaborate on how they are particularly powerful: Vaccinations and Healthier Mothers and Babies.
Since the first time my pediatrician explained the reason I had to get a certain shot before entering a new school, I have found vaccinations to be extremely interesting. It seems amazing that just 100 years ago, I would have known people suffering from measles, mumps, and small pox whereas today those diseases sound as antiquated as the Bubonic Plague. It is even more impressive that a disease that was a part of the normal elementary school experience when I was younger, chicken pox, is now joining that list. Last year, I was extremely impressed with the speed and precision with which the H1N1 vaccine was developed and produced. It is fascinating to think of what infamous global pandemics could have been avoided if today's vaccination technology had been in place (the Spanish Flu, the small pox plagues that decimated Native American populations, etc.).
Today, many activists have been campaigning against vaccines due to concerns about a link between vaccination and autism. However, the Lancet journal article that initially sparked this concern was recently retracted due to inappropriate research methods. This means there is absolutely no proof supporting this claim. If vaccination rates were to drastically decline in the future, the public health of the US population would be seriously at risk.
Interventions regarding healthier mothers and babies also have a strong impact on the population level. The past century has seen tremendous improvements in this area. However, my interest in this intervention is mostly centered on the work still to be done. The US is 45th on the list of countries with the lowest infant mortality rates. This is well behind almost every European country and many countries that could be considered "less developed" than the US. The high infant mortality rate in this country is mainly due to a health disparity. African-American infants and infants with low SES have much higher rates of infant mortality than almost all other American groups. In fact, the infant mortality rate in East Baltimore is worse than many extremely impoverished nations. In the next century, I believe public health interventions will be integral in eliminating this disparity.
One Public Health intervention that I was surprised not to see on the list is air quality improvement. Although this is still an uphill battle, the 20th century saw key legislation, supported by public health experts, to improve the quality of the air. The most important of these may have been the ban of leaded gasoline. Since the switch to all unleaded fuels, air quality has improved dramatically. Also, indoor air quality has been improved by indoor smoking bans that have been quickly gaining popularity throughout the country. Although initially laws simply segregated smokers and nonsmokers within a restaurant, today many cities ban smoking indoors altogether. Maybe this intervention will have a place on the top ten for the next century.
That's all for this week. Stay warm!
This week's blog is about the top ten greatest public health interventions of the 1900s. Too bad one of them wasn't an instant snow remover or a fireplace I can use in my apartment. It's the snow-pocalypse out there! Anway, hopefully this blog will keep someone occupied as we wait out the blizzard.
The Top Ten Interventions are:
1. Vaccination
2. Motor Vehicle Safety
3. Safer Workplaces
4. Control of Infectious Diseases
5. Decline in Deaths from Coronary Heart Disease and Stroke
6. Safer and Healthier Foods
7. Healthier Mothers and Babies
8. Family Planning
9. Flouridation of Drinking Water
10. Recognition of Tobacco Use as a Health Hazard
Wow! Public Health sure has accomplished alot in the last century. What really shocked me is that since 1900, average life expectancy has grown by more than 30 years! Public Health is responsible for 25 of those years which is truly a feat to be proud of.
One of the most interesting things about this list is that almost everyone has been effected by most if not all of the interventions. We all benefit from the flouridation of drinking water, healthier foods, and safer workplaces. Also, infant and child mortality declines were helped by maternal health reforms and vaccination campaigns which have eradicated or severely lessened many diseases that were previously devastating. As any high school graduate can tell you, education programs regarding motor vehicle safety and tobacco as a health hazard are unavoidable. Also, when purchasing a new car, we often take for granted the anti-lock brakes, side-impact air bags, and seat belts that have saved so many lives. Next, as a woman, I particularly value the family planning interventions that were integral in both improving women's health and facilitating the women's liberation movement. Finally, since cardiovascular disease is currently the number one killer in the United States, any interventions that reduce the number of people dying from these diseases are important to all Americans.
Today, I will take just two of these interventions and elaborate on how they are particularly powerful: Vaccinations and Healthier Mothers and Babies.
Since the first time my pediatrician explained the reason I had to get a certain shot before entering a new school, I have found vaccinations to be extremely interesting. It seems amazing that just 100 years ago, I would have known people suffering from measles, mumps, and small pox whereas today those diseases sound as antiquated as the Bubonic Plague. It is even more impressive that a disease that was a part of the normal elementary school experience when I was younger, chicken pox, is now joining that list. Last year, I was extremely impressed with the speed and precision with which the H1N1 vaccine was developed and produced. It is fascinating to think of what infamous global pandemics could have been avoided if today's vaccination technology had been in place (the Spanish Flu, the small pox plagues that decimated Native American populations, etc.).
Today, many activists have been campaigning against vaccines due to concerns about a link between vaccination and autism. However, the Lancet journal article that initially sparked this concern was recently retracted due to inappropriate research methods. This means there is absolutely no proof supporting this claim. If vaccination rates were to drastically decline in the future, the public health of the US population would be seriously at risk.
Interventions regarding healthier mothers and babies also have a strong impact on the population level. The past century has seen tremendous improvements in this area. However, my interest in this intervention is mostly centered on the work still to be done. The US is 45th on the list of countries with the lowest infant mortality rates. This is well behind almost every European country and many countries that could be considered "less developed" than the US. The high infant mortality rate in this country is mainly due to a health disparity. African-American infants and infants with low SES have much higher rates of infant mortality than almost all other American groups. In fact, the infant mortality rate in East Baltimore is worse than many extremely impoverished nations. In the next century, I believe public health interventions will be integral in eliminating this disparity.
One Public Health intervention that I was surprised not to see on the list is air quality improvement. Although this is still an uphill battle, the 20th century saw key legislation, supported by public health experts, to improve the quality of the air. The most important of these may have been the ban of leaded gasoline. Since the switch to all unleaded fuels, air quality has improved dramatically. Also, indoor air quality has been improved by indoor smoking bans that have been quickly gaining popularity throughout the country. Although initially laws simply segregated smokers and nonsmokers within a restaurant, today many cities ban smoking indoors altogether. Maybe this intervention will have a place on the top ten for the next century.
That's all for this week. Stay warm!
Tuesday, February 2, 2010
First Impressions
Hi everyone. My name is Michelle Perez and I am a senior public health and spanish major at Johns Hopkins University. This blog is an assignment for the course "Intro to Public Health." In this blog, I will tackle issues discussed weekly in class, as well as bring in my own opinions and political views. I hope this blog will tie in-class academic discussions to real issues in public health around the world.
Obviously, as a public health major, I am invested in public health issues. I will be attending medical school in the fall and feel that my public health background has made me a more well-rounded individual. Also, it is important to consider the health of the public as a whole when making individual patient-centered choices. Public health offers the unique opportunity to influence health on a population level and to work towards eliminating social injustices and health disparities.
Firstly, for those of you who are unfamiliar with public health, I'd like to explain exactly what it is. An important aspect of public health is that it is focused on the health of the population as a whole. Public health studies and initiatives are aimed at improving health at the macro level. Also, public health takes a proactive approach. Goals include preventing unhealthy conditions instead of just resolving issues after they occur. In summary, public health focuses on supporting the conditions which lead to good health on the population level.
Within public health, I find many areas very interesting. These include maternal and child health in developing nations, refugee health issues, and healthy policy issues (including issues surrounding the restructuring of the American health care system). I think that these three areas provide a good summary of the diverse array of issues public health can be used to address. The first, maternal and child health, can be seen as a fairly straightforward issue of health access and education in developing nations. The problem-solving methods employed by public health programists must focus both on developing access points, financing care, and building a structure that can be sustainable. The second issue, refugee health, combines a health problem with a political one. Refugees often suffer poor health as a result of being forced from an unstable political climate. Within public health, it is necessary to both identify the population and identify their specific health needs. Lastly, health policy issues tap the economic and political aspects of public health. In developing public health policy, experts must consider various stakeholders and attempt to make decisions that benefit the most people.
So far, class has been very interesting. The first day broke down the important parts of public health and explained each. One of the most interesting things about public health is the way natural science focused disciplines, such as epidemiology and biostatistics are blended with more social science focused disciplines such as law and politics. I also found it extremely interesting to note that public health changes in the areas of santitation, food and water quality, and urban overcrowding were the cause of the major mortality dip in the 1900s. I also enjoyed the analysis of what goes into a policy (science, culture, and politics). I think that people too often focus on only one of these and forget that policy is normally a conglomerate of these competing factors. I hope to learn more about these issues and much more throughout the course.
Thanks for reading! Until next time....
Obviously, as a public health major, I am invested in public health issues. I will be attending medical school in the fall and feel that my public health background has made me a more well-rounded individual. Also, it is important to consider the health of the public as a whole when making individual patient-centered choices. Public health offers the unique opportunity to influence health on a population level and to work towards eliminating social injustices and health disparities.
Firstly, for those of you who are unfamiliar with public health, I'd like to explain exactly what it is. An important aspect of public health is that it is focused on the health of the population as a whole. Public health studies and initiatives are aimed at improving health at the macro level. Also, public health takes a proactive approach. Goals include preventing unhealthy conditions instead of just resolving issues after they occur. In summary, public health focuses on supporting the conditions which lead to good health on the population level.
Within public health, I find many areas very interesting. These include maternal and child health in developing nations, refugee health issues, and healthy policy issues (including issues surrounding the restructuring of the American health care system). I think that these three areas provide a good summary of the diverse array of issues public health can be used to address. The first, maternal and child health, can be seen as a fairly straightforward issue of health access and education in developing nations. The problem-solving methods employed by public health programists must focus both on developing access points, financing care, and building a structure that can be sustainable. The second issue, refugee health, combines a health problem with a political one. Refugees often suffer poor health as a result of being forced from an unstable political climate. Within public health, it is necessary to both identify the population and identify their specific health needs. Lastly, health policy issues tap the economic and political aspects of public health. In developing public health policy, experts must consider various stakeholders and attempt to make decisions that benefit the most people.
So far, class has been very interesting. The first day broke down the important parts of public health and explained each. One of the most interesting things about public health is the way natural science focused disciplines, such as epidemiology and biostatistics are blended with more social science focused disciplines such as law and politics. I also found it extremely interesting to note that public health changes in the areas of santitation, food and water quality, and urban overcrowding were the cause of the major mortality dip in the 1900s. I also enjoyed the analysis of what goes into a policy (science, culture, and politics). I think that people too often focus on only one of these and forget that policy is normally a conglomerate of these competing factors. I hope to learn more about these issues and much more throughout the course.
Thanks for reading! Until next time....
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