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A Book Review: “Deadly Outbreaks” by A.M. Levitt, PhD

December 1, 2013

sam racoon hat dec 2013Phewww. It’s cold outside! This precious pic is my five-year-old grandson snuggled with a furry raccoon stuffed animal and wearing a soft and cuddly raccoon hat. For his nap. He knows how to stay warm!

I recently finished reading Levitt’s book, “Deadly Outbreaks: How Medical Detectives Save Lives Threatened by Killer Pandemics, Exotic Viruses, and Drug-Resistant Parasites.” []

Published by Skyhorse Publishing in 2013, this book could provide the basis of a TV drama series and contribute to the audience’s understanding of how public health is organized and delivered in the US and why so many large nations want to model our approach.

The author hopes to introduce readers to field epidemiology, even getting them excited about it as a possible career choice. Because the book is carefully researched and provides a thorough narrative regarding the seven cases highlighted, she may achieve that aim. For these reasons, I will recommend it in future health communication seminars I teach and recommend it to you as well. Here’s more about why.

The CDC’s Epidemic Intelligence Service trains medical detectives, doctors who want to track down the source of population and health risks and guide the public health response. Dead birds, mosquitoes, New York City parks, and West Nile virus–collaboration with animal health officials brought a focus to disparate views about what was happening and what needed to be done in the book’s opening case.

Levitt then moves to a case giving us a historical context for modern policy related to refugees medical screening and movement into the US. This is a chapter that makes clear the need to be assertive in the public health sphere when faced with competing political agendas, to exercise skills that don’t traditionally come to mind when identifying the meaning of epidemiology. These skills include the ability to talk to [not ‘at’] members of local communities and to engage in participant observation, taking thorough notes to document both.

The third case takes us behind the scenes of a hospital in order to uncover the origin of unexplained deaths of children. A wide range of possible explanations were considered and found to be insufficient, including toxic fumes from repair work on the roof entering through air ducts. The point-by-point discourse guides us to both a conclusion and to new policy as accepted practice in most US hospitals today.

The fourth chapter guides the reader through the 1970s case of Legionnaires’ disease. Perhaps because I remember this one well, I was fascinated to read what was going on behind the scenes.

The last three cases introduce other contexts where the public’s health can either be supported or quickly go awry. I will never be on the interstate again passing a tanker-trailer truck labeled as carrying anything related to food without wondering about the conditions for keeping the food safe and bacteria free. Right now, most of the media images of the snowfall and road accidents involve those large semis. How many of them are carrying food-related products and what happens as they have to wait out the storm? What protocols kick-in? I feel comforted, but likely falsely so, that it is cold rather than blistering heat leading to breakdowns. I am thinking that keeping the chill on reduces bacteria’s chance to grow, thought it does not die, as discuss in the fifth case in the book. The case introduces us to FoodNet, a national surveillance system supported by the CDC to track foodborne pathogens.

The sixth chapter explicitly introduces the reader to the important principle of medical detectives sleuthing by asking ‘what if’. Asking that question and revealing the conversations that ensue really does remind me of one of the TV drama show that has been number one for years now and Abby’s character at work in the lab. Different context further broadened with the case in the last chapter. Not one we often have the privilege of looking behind the curtain at. But fascinating and filled with content to engage and inform. I highly recommend this book. Not one for light reading, but one that you will be glad you invested your time in.

Public Health and Health Insurance as a Public Good: Part 3

October 30, 2013

IMGP3157While the media has given a lot of coverage to citizens complaining about having to pay for health insurance for pregnancy when they are men or have wives past child-bearing age/interest, or for pediatric care, or birth control–the story being lost is the one about health insurance as a public good. If all citizens have access to a certain level of care, then all citizens should achieve a certain level of health, and that should be good for all of us, the public good associated with health insurance and the public’s health.

Of course, we hear these arguments in other contexts. There are people who don’t have children who don’t want to pay for public schools. People who don’t use the interstate system not wanting to pay for maintenance of the interstate system. So it seems to be a very old tune, but the words for the new verse haven’t been rehearsed very well. Without telling more about how sharing the cost of paying for a level of health care aims to benefit all of us, complaints get heard and the argument for the ACA gets lost.

Likely, over time, debates will unfold as data collects to support or fail to support ACA’s benefits for society. Will we improve on some of the major health indicators, such as infant mortality rate–with the U.S. ranking 30th on a recent list []. That is the hope. It will likely take some discussion and some effort to work toward achieving such aims. And some revision of the ACA. A foundation of understanding related to its purpose is a good place to start.

Public Health in the U.S., Public Good, and the Affordable Care Act: Part II

October 20, 2013

IMGP3159Most of us learn at a very young age what “medical doctor” means. Far fewer of us learn what “public health” means. Our nation’s public health system functions largely as a backdrop to promote the well-being of all of us in the U.S.  As a member of the Institute of Medicine–IOM–committee that wrote the report, “Who Will Keep the Public Healthy: Educating Public Health Professionals for the 21st Century,” []  this reality emerged time and again, as we discussed and debated the roles that the public health force play.

I often teach Korean and Chinese graduate students who look to the U.S. for a model for public health and how to organize and deliver it in their countries where policies are newer and emerging.We tend to take for granted that someone has inspected the safety and health of restaurants where we eat, the meat and produce that we buy to consume, and the water quality coming into our work sites and homes. These “luxuries” sometimes become more salient when we visit outside the boundaries of the U.S.  In reality, these illustrate ways that our health is being safeguarded, not only for our individual well-being but for the health of all of us–with inoculations required for public school one of the most recognized acts taken for this aim.

The public good is served when actions are taken to protect and promote the health of each one of us as individuals in order to reduce the likelihood that any one of us will contribute to the illness of others and/or incur costs linked to the poor health of others. This principle frames some of the actions taken as part of the Affordable Care Act but has not been emphasized or clearly explained.


Weighing in on…’pink slime’

March 23, 2012

I am sure that you’ve all heard about it. But just to be sure we are on the same page, let me share a brief story about ‘pink slime’ below so you know what I am talking about. I guess one of my favorite comments I’ve heard during this discussion came from a vegetarian who stated, “If I knew where my meat was coming from, I might eat it.” For me, it is the use of the word “lean” that gets me. Count the number of times it appears in the news story here. It really makes me wonder how often I have purchased really ‘lean’ ground beef in the past and got it at a good price–but really wasn’t getting what I thought I was buying.. Hmm. And when did pink slime first get added to our meat supply? Anyone know?

Did you hear about the voluntary recall of Bufferin products?

January 9, 2012

I’m back. It was a fabulous break. The piles on my desks at home and on campus grew smaller. I was nourished by hugs and kisses from my grandchildren, children, and parents. I set some new goals for the next five years that include using up all the good stuff that I have a tendency to ‘save’. And I heard a lot of communication about health that I can’t wait to start sharing. But a news’ story this morning set today’s topic for me.

You see, I have this gallon size resealable plastic bag that I have been carrying around for months now. Inside the bag are broken aspirin. I thought it was just me and just the bottle I purchased. But it turns out that a lot of people have been complaining about this problem. And so today, the company making these products issued a ‘voluntary’ recall. Here is a link to a list of products being recalled — It includes Bufferin and Excedrin products.

And according to this story — — the problem may be more than quality control related to broken pills. Stray pills or parts of pills may be getting mixed into products. So please check this out and share the recall information with friends and family members who may use these products. Doing so is an important part of communicating about health.


What do we say to youth about exercise?

April 13, 2011 GUEST BLOG POST by Elliot Searer

In many previous studies, we have found out that a healthy balance of diet and exercise is the most efficient way of staying healthy.  I feel more emphasis needs to be put on children and how much physical activity they receive, and if they are even coming close to the recommended 60 minutes per day.  I feel that organizations, like YMCAs, should offer more opportunities for our youth to have a place to properly exercise. Questions I have are:

Do our youth have proper access to a clean, safe environment suitable for physical activity and play?  Do our youth understand the importance of physical activity from a health perspective?  Do our youth have access to information that answers their questions about different exercises or exercise equipment?  Do children understand the importance of nutrition in order to gain the most from their physical activity?  Are youth who lived in dirty, unsafe conditions permitted to exercise at facilities like YMCAs despite possibly not having the proper financial means?

In a study conducted by Bowman and Neal, particpants between 5 and 17 years of age were scheduled to attend nutrition classes only or nutrition classes and family YMCA membership. The primary outcome measure was change in BMI-for-age percentile.  Four participants in the control group and one in the treatment group achieved the target reduction of 2 BMI percentile points.  Within the treatment group overall, YMCA attendees had a mean increase of 0.30 BMI points compared with an increase of 0.60 BMI points in nonattendees.  Questions I have about the study in particular are:

1) In what type of shape, physically, were the eligible participants in before the experiment?  2) After? 3)  What type of guidance was received from YMCA workers or someone of a trainer’s capability?

Through my personal experiences as an athlete, I find it extremely surprising that better results weren’t seen.   The study states that some of the participants didn’t even go to the YMCA despite having a paid membership.  I would like to know what type of guidance they were getting.  For example, if they were doing proper exercises to promote weight loss or if they even knew how to properly operate the equipment and machines. 

I feel a lot more can be done by communities to stress getting the 60 minutes of daily physical activity.  Organizations should take a stronger stance and venture out in the community, and set up activities in parks or rec sites.  It wouldn’t be hard, and would be low cost.  Also, the organizations may not even have to use their facilities as host sites for the gatherings.  Getting our youth out in the community, learning how to properly take care of themselves through physical activity could possibly lead to more benefits.  Better eating habits, spreading nutrition information to other family members, and overall healthier communities may encourage children to pursue sports or other careers based on exercise/play as opposed to sitting at home…

M. A. Bowman and A. V. Neal;  Policy and Financing in Family Medicine and the Medical Home.  J Am Board Fam Med, May 1, 2010; 23(3): 277 – 279.

What is “public health” anyway?

copy-of-p3061598March 1, 2010

As children begin to know about roles and jobs, some will say, “I want to be a doctor.” Their parents buy them a ‘doctor’ kit to play with, and they practice being a doctor. I never hear a child say, “I want to work in public health.” Why is that? What’s wrong with this picture?

Public health isn’t part of the usual high school curriculum, so we don’t get an introduction to what a career in public health might look like. When health education is taught in high school, the course doesn’t introduce students to the public health system. And so, not surprisingly, few of us know what public health is or what the public health system does. 

Public health often treats health as a public good. A public good is something for which the benefits for one of us cannot be separated from the benfits for ‘all’ of us. When I get a flu shot, I am supposed to benefit by not getting the flu. But others benefit because they do not get exposed to the flu from me. 

So monies spent to inspect restaurants or public pools benefit every member of the public who eats at the restaurants or uses the pools, not just one of them. Monies spent for newborn screening programs benefit all of us because we identify conditions at early stages when prevention or care may limit the harm, and all of us benefit by having a friend or neighbor who can be a healthier and more productive citizen.     

School vaccines. Programs for reproductive health. Collection of data about births and deaths–vital statistics that can show patterns and be used to suggest how to improve birth outcomes and decrease deaths. Cancer registries. Programs to prevent disease and accidents. All of these and more are prt of public health’s efforts to promote the public good.

Is the public good “good” for me? Often it is. Sometimes, it may not be.

There are limits to what vaccines I want to be used as gatekeepers to my employment. But there are even more limits to what genetic tests I want to be used as gatekeepers to my free choice to pursue life paths. So the first step is to become aware of what public health means what public does. Then we can advance agendas relating to support for public health and guidelines about where to draw the line in the name of promoting the public’s health.

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