All in the Same Boat

Swine Flu Scare

The so-called swine flu burst upon us a couple of months ago in a crescendo of media coverage. We could imagine a new plague slaying tens of thousands. When we heard about "Rosita," a nine-year-old girl in Mexico who died of H1N1 flu, that put a human face on the abstract numbers. One individual human story moves us more easily than does a recitation of numbers of similar deaths. We can more readily imagine ourselves, our family members, even our own little girl, when we see a concrete individual situation.

Today, it looks like H1N1 is not the disaster we feared. The death rate has turned out to be less than the ordinary flu occurring every winter. As of this writing, around 100 people have died worldwide, compared to about 36,000 deaths (one percent of those infected) from the flu in the US each year.

The initial strict precautions, however, were not a mistake. Health departments had to think of the community, of the millions at risk. This flu could have been like SARS, killing one person of each ten infected, with a total death toll of 8,000 before it was stopped. And avian influenza, reports local infection control nurse Liza McKenzie, "is another related example supporting the initial strict precautions used in responding to H1N1. Since 2003 there have been 433 cases of the avian flu and 262 of these were fatal."

So, until we knew what we were dealing with, we had to exercise our one chance to control a potentially horrible epidemic as this one might have been. Since the swine flu now appears not to be as dangerous as SARS or the avian flu, the restrictions have been loosened. At this time, the Centers for Disease Control in Atlanta and the World Health Organization are turning their attention to the Southern Hemisphere, where the flu season will shortly begin, to monitor the novel H1N1 flu to be sure the virus does not become more virulent. More information is available on the World Health Organization's H1N1 site.

Public Health Heroes

The success with SARS, and indeed much of our good health today, arises from the intelligent exercise of public health measures. Public health physicians are the unsung heroes of modern medicine. We have great respect for cardiologists with their high-tech procedures and breath-taking skills. How proudly a mother says, "My daughter, the cardiologist." Could she brag as easily about her child who grew up to be a public health officer? A cardiologist can save one photogenic child and garner more fame than any public health physician, yet public health work saves thousands of lives, and more than thousands.

You history buffs know that malaria was endemic in the US in the early years of our nation. You could catch it in Philadelphia and all points south. We had no drugs for it except cinchona bark. However, malaria requires the conjunction of a certain kind of mosquito, with the malaria organism and with humans — a deadly reunion we call the malaria triangle. Public health authorities were able to eliminate it from the United States by keeping those three elements apart. They worked to reduce or treat the standing water required for mosquito reproduction. They kept humans and mosquitoes apart with the use of bed nets, window screens, and screen doors. They broke the cycle for a season, and endemic malaria disappeared.

Those efforts continue today. While the Centers for Disease Control in Atlanta garner the headlines, our own Jefferson County Public Health (JCPH) quietly protects our health here locally. In the days after 9/11, when the anthrax murders occurred, Dr Tom Locke of our JCPH briefed us on that issue. We learned that JCPH, in conjunction with state and national authorities, had been for years preparing for that type of disaster and many others.

Occasionally someone complains that JCPH regulations, such as those regarding septic systems, seem onerous. However, we as a community benefit from reasoned efforts to eliminate preventable illness. JCPH probably spends more time and effort than anyone else in working to establish and support regulations that allow businesses to function and people to build homes, while still protecting us from dangerous food and water.

The Secret of our Longer Modern Lifespan

You and I know that as long as we in our developed country are in reasonable health, we can expect a lifespan of over 70 years. Our longevity is not due to cardiac catheterizations, to statins, or to MRIs. We can expect to live so long because the great scythes of death – plague, malaria, and many other epidemic infectious diseases – have been eliminated in the Western world. We have clean food, water, and air, and healthful places to live. None of that happened by accident.

Public Health in Past Times

Public health efforts started a long time ago. The ancient Romans found their cities were unhealthy, so they developed aqueducts and sewers. A British physician named John Snow stopped a cholera outbreak in London in 1854 by deducing which public water source was causing the deaths and having the handle of the Broad Street pump removed. Koch, Pasteur, and a legion of microbe hunters worked out the causes of infectious illness and spared millions of people the agony of malaria, yellow fever, typhoid, polio, diphtheria and a host of other scourges.

Now we prevent many of these with vaccines. And while work continues to improve that process, those childhood immunizations have prevented millions of small caskets from being occupied.

Public Health Here and Now

As our elected officials continue to wrestle with the problem of providing ever more services with ever-shrinking tax dollars, let us not forget that sometimes the only solution is to support these public health efforts with our tax contributions. Public health measures prevented your child from developing diarrhea last week from tainted food. You mother did not die of SARS in 2002, because it was stopped, for the most part, at the US border. Your sister is happy and active since she was immunized, so she did not catch polio during the sixties.

As we look at the ongoing debate about our nation's healthcare, it's important to remember that we are all in this together. History tells us, without equivocation, that we have gained most of our health improvement by attending to our health as a community. Financial resources that we provide for that purpose serve us. To sequester such resources for ourselves, to imagine we might live forever had we enough money, to allow that to prevent us from supporting public heath is, paradoxically, our least life-supporting choice. To paraphrase what an older and wiser head once said to me: "Be kind and generous to all; you never know who will be wiping your brow as you lie dying."

We as Americans are proud of our individuality; we relate to individuals more strongly than we do to statistics and numbers. Yet many of us alive today owe that life to public health efforts, efforts based on the understanding that community and individuality are not opposites; each depends upon the other. We are, foundationally, all in the same boat.