Public Health Agencies

Public Health Overview:

Throughout the world there are organizations who work together to increase the world's awareness of disease, its causes, how it is spread, and how it can be prevented in order to ensure the safety of communities throughout the entire world. Public health organizations are overseen by governmental agencies.

In the United States, the principal federal health agency is the Public Health Services division of the Department of Health and Human Services overseen by the Surgeon General. This is comprised of several different agencies:

The National Institutes of Health (NIH), which conducts research on AIDS, immunology, heart disease, neurology, and blindness.
The Centers for Disease Control and Prevention (CDC), who maintains statistical data on all diseases, pinpointing cause and effect of newly emerging diseases.
The Food and Drug Administration (FDA) is responsible for overseeing the effectiveness and safety of food, drugs, and cosmetics.
The Alcohol, Drug Abuse and Mental Health Administration is a more recent organization, established by congress to address substance abuse and mental health issues.

Because the world is expanding, travel is more readily available, and individuals can expect rapid transit from one part of the world to another, there is an ever expanding need for the monitoring of public health on a global basis.

The United Nations established the World Health Organization (WHO) for this purpose. It used to be that health issues were very localized, but with the globalization of the world, diseases can quickly spread throughout the world. Because of this, it is vital to the health and safety of the entire world for an organization to be aware of potential disease "hot spots" so that everyone can be alerted.

Public Health Responsibilities:

Keeping the population safe and preventing serious outbreaks of disease are the responsibilities of the various agencies of public health, and these are divided among local, state, and federal governmental agencies. Health officers, physicians, nurses, and many other health care personnel are provided.

Public Health officials are responsible for:

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Overseeing water purity
Food supply and the people who handle the food.
Health of animals that supply food.
Extermination of wildlife, rodents, and insects that cause disease.
Pollution in air and water.
Assure water safety for drinking, swimming, and as a food source.
Collect vital statistics on death rates, birth rates.
Collect information on communicable and chronic diseases.
Watch other indicators on the state of public health.

Tuberculosis Scare:

Public Health officials are also responsible for the inspection of people and goods that enter our country to ensure that they are free of contagious disease. They have the power to put people under quarantine if necessary for the good of the public. You may remember Andrew Speaker. On May 10, 2007, Mr. Speaker met with Public Health officials in Fulton County, Georgia who informed him of his condition of a drug-resistant form of tuberculosis and indicated that he should not travel in his condition. Rather than obeying those instructions, Mr. Speaker left the United States on May 12, 2007 to travel to Greece for his wedding, intending to return on June 5, 2007. Mr. Speaker traveled on no fewer than seven commercial flights, thereby exposing hundreds of passengers to a potentially fatal form of tuberculosis, before returning to the United States where he was finally placed under quarantine, first in Atlanta, then in Denver, setting of an international public health scandal. Mr. Speaker underwent treatment in Denver until July 26, 2007 at which time he was finally released being deemed no longer contagious.

http://travel.nytimes.com/2007/06/02/health/02tick.html

History of Public Health:

We frequently view Public Health as a modern concept, though it has actually been in action for centuries. It has long been established that polluted water and lack of proper waste disposal is responsible for the spread of communicable diseases. Some of the early religions tried to handle this by regulating behavior from the types of food their people were allowed to eat to consumption of alcohol and certain sexual practices. Governments later established agencies where such leaders were responsible for the development of public health policies and programs in order to understand what caused disease in order to promote social stability and to maintain order in their people.

The Romans understood that they needed to handle human waste in order for their people in urban areas to remain healthy. The Chinese were responsible for the precursor to the vaccination by the practice of variolation against smallpox around 1000 BC, work that Edward Jenner improved upon with his cowpox vaccination in 1796. During the years of the Black Death plague in Europe, many believed that removing the dead bodies would help to prevent the spread of the infection. While this was a good idea, it really did little to stop the onslaught of the deadly disease that is transmitted by rodent-borne flees. Burning parts of the city provided much better results because the fires destroyed the homes of the infected rodents. At that time, many people believed in what was termed the "miasma theory of disease" believing that disease was spread by "bad air", and on many levels this was not completely wrong. By washing and keeping windows open, the spread of much disease was prevented. Unfortunately, this did little to handle the problem of water-borne or rodent-borne diseases. Because of the conflicting theories, the science of epidemiology was established when John Snow identified a polluted water well as the ground zero point of infection for the 1854 cholera outbreak in London. Dr. Snow believed more in the "germ theory" of disease rather than the "miasma theory" of disease. The "germ theory" promoted the controversial belief that microorganisms were responsible for the spread of disease, leading to the field of study called microbiology. Epidemiology studies all factors affecting disease in populations of people, promoting interest in public health and prevention techniques. This will be discussed in greater detail in a later lesson. Modern Public Health:

During the past 100 years, specifically in the 20^th century, the increase in life-span is remarkable, and is due to the public health programs of vaccination, infectious disease control, and vehicle and occupational safety, and programs to help reduce the incidence of chronic disease.

There are still public health issues that can affect us on a daily basis; newly emerging diseases such as SARS, HIV-AIDS, possible bird flu pandemic among others.

The Special Pathogens Branch (SPB) of the CDC works closely with WHO when it comes to worldwide health issues such as infectious pathogens, such as bola hemorrhagic fever, tularemia and anthrax as potential biologic weapons, hantavirus outbreaks where their job is to:

Develop tools to quickly and accurately identify high hazard disease.
Gather information about the disease and the geographic distribution.
Provide patient care guidance for infected individuals and those who may become infected.
Conduct studies to increase knowledge and information of high hazard diseases for better control and prevention.
To respond to global outbreaks and offer direct assistance in detection, prevention, and control.

Diseases of Concern:

Ebola, Lassa fever, Rift Valley fever, Bolivian hemorrhagic fever: These are highly contagious and deadly diseases that have the potential to become pandemics, though transmission does require close contact with an infected individual. Swift diagnosis and quarantine help to prevent the spread of such pathogens. Genetic mutations can occur, putting these under the watchful eyes of disease specialists worldwide.

Antibiotic resistant microorganisms:

Sometimes called "superbugs", one of which we mentioned earlier, these have become of greater and greater concern since 1980. Tuberculosis cases that are antibiotic resistant are a cause of major concern. WHO has established that there about 50 million people around the world who are infected with multiple-drug resistant strains of tuberculosis. Over 125 cases were reported in the United States in 2005. An especially resistant strain was identified in Africa in 2006 and has been found to exist in seventeen other countries including the United States.

Other "superbug" concerns are common bacteria such as staphylococcus aureus, enterococcus, and serratia marcescens which have all become drug resistant in the past 20 years. Complacency is largely responsible for the development of superbugs, as was the over-prescribing of antibiotics for non-life threatening illnesses. Complacency, because we believed we had conquered bacteria and stopped looking for new medications to battle disease. Once the new superbugs arrived, the FDA and the drug companies realized that there is a huge responsibility to continue to work toward better and better antibiotics.

HIV – AIDS Infections:

Responsible for more than 25 million deaths since it was first identified in 1981, the AIDS epidemic is one of the worst in history. It is considered to be of pandemic proportions. Believed to have originated from chimpanzees, AIDS killed over 2.1 million people in 2007 including over 300,000 children.

SARS

This arose in 2003, and is a highly contagious form of an atypical pneumonia caused by a coronavirus, which is largely responsible for the common cold. The SARS-CoV, however, has the potential to become pandemic. Quick action by national and international public health officials, such as WHO, have helped to slow the transmission and this ended local epidemics before they became pandemics. The disease has not been completely eliminated, and could spring up unexpectedly in the future, warranting continued monitoring of suspicious cases of atypical pneumonia.

Influenza

Usually influenza is hosted by wild aquatic birds, but has been known to be transmitted from species to species giving rise to domestic poultry infections. The most virulent and concerning form right now is the H5N1 avian influenza virus first detected in 2004 in Vietnam. In 2005 there was widespread concern of a worldwide pandemic that could kill over twenty percent of the entire world's population. By the end of October 2007, however, only 59 people have died as a result of this infection. This is the most current pandemic threat we see, and WHO has listed it as a Level 3, (no or very limited human to human transmission) alert.