Contagion (Blog 7)

This blog is discusses aspects of the movie “Contagion” directed by Steven Soderbergh.

Beth returns home from Hong Kong, while she is ill. She infects her son and they both die but her husband (Mitch) is immune. The virus spreads around the world rapidly but health officials do not immediately realise the severity. The CDC identifies the virus and develops a vaccine, while the world is crumbling around them. This movie show how important public health is. Doctors could only treat the virus in individuals after they had been infected, which is both too late and ineffective. Public health officials try to contain/treat the virus on a large scale, which is much more efficient than treating only individuals.

An outbreak occurs when the number of people with an illness is significantly higher than the norm. An outbreak investigation is following cases (looking at all those exposed), attempting to identify the cause, diagnose the problem and then implements treatment. Isolation is the separation of people who are ill from healthy people. Quarantine is the separation of people who have been exposed to an illness (to see if they develop symptoms) from those who have not been exposed. All of these were in the movie. There was a virus outbreak, the CDC conducted a nation-wide and worldwide investigation, Mitch was quarantined and they attempted to isolate those who were ill but the number of those who were was too great.

There are many ways that the CDC and other authorities could have been better prepared. Most importantly, authorities need to be better prepared for disasters. There did not seem that there was a plan in place to implement. In all fairness, no one could have expected how far reaching the virus would be – but they should have been some sort of general emergency plan. For example, there were not enough blankets for the ill in isolation; the dead were put into hastily constructed mass graves, which could damage the water supply. Also, public services stopped, creating risks of different diseases and health issues. Since everyone was panicked, crime skyrocketed – the authorities should have planned on using the military sooner. Finally, there was not enough food; the plan should have contemplated how to get food to people.

Another issue that could have been better prepared was the spread of information. For example, when Mitch and his daughter were traveling to another city they ended up being turned around on the outskirts, like many others. To address this, there should have been a way to mass communicate, like emergency channels. Also, there was a serious spread of misinformation. Of course there are always people that are going to take advantage of a situation for profit but this could have been better combatted. The CDC was tight-lipped about the virus for too long, so when they started releasing concrete information, people still believed that they were holding out on more information.

On the farm we had an outbreak of a pulmonary respiratory virus in our cattle herd. Within days we had over a dozen claves got sick and died quickly without any apparent explanation. It took a few autopsies to determine the best course of action. We couldn’t get the cattle to the corral to be treated (so we had to treat them in the pasture), but this was time consuming and in the meantime more calves got sick and died. There was a feeling of being helpless when so many got sick and died so quickly…

Effects of Climate Change (Blog 6)

This blog discusses the effects of climate change on the general public’s health and possible ways to deal with the issues that we face. The information is from “Climate Change: The Public Health Response”.

Two climate change issues that severely affect people in my area are: winter weather anomalies and droughts, floods, and increased mean temperature. Winter anomalies are essentially the same as droughts and floods. As you can imagine, in Canada we get a lot of snow and cold weather. Most of our precipitation comes in the form of snow. If we do not get the enough snow it is a drought. The soil is not going to be very fertile because there is no water for the crops to suck up. If the crops don’t have enough water there is a lot of loose soil blowing around (think the “Dirty ‘30s”). Blowing soil harms the respiratory system and affects eyes (too much soil in the eyes).  On the other hand, if we get too much snow, when spring comes it takes a lot longer to melt. If seeding is done late, the growing season will be too short. People will be forced to harvest the crops before they are ready. This means that the crops will be moist when harvested. This wreaks havoc on the public’s respiratory systems. Imagine being in a musty environment for a long period of time. A significant consequence is higher levels of ochratoxin A (OTA). Higher levels of OTA have been shown to cause kidney failure, particularly in infants. This is not very well known but is a very serious issue - levels higher than 5 parts per billion or 2 kernels in an 18-wheeler truckload are toxic for infants (Prairie Oat Growers Association). Also, in this moist environment bacteria thrives and all of the resulting health consequences.

I was surprised to see that climate change affects people’s mental health. People in areas with continuous climate issues would have a burden. I was not aware that people who are not displaced worry about climate change so much that they have mental health issues.

Mitigation (primary prevention) in the context of climate change is to reduce green-house gas emissions in order to slow or even reverse climate change.  Adaptation (secondary and tertiary prevention) prepares for the effects on public health resulting from climate change.

If many people from the same area are getting sick, public health officials would look at how the patients are connected. The people turn out to be using the same well for their water. As a result of the increased mean temperature, bacteria is able to thrive in the well. By tracking the trends, the source of the problem was located, so the issue could be rectified.

A government agricultural experimental farm is located just outside our town. Their research primarily focuses on how to make crops survive and thrive with climate change. If the crops are better prepared for climate change, many of the health issues decline significantly. As previously stated, the most obvious health issues our area a result from bad crops. As we are located in the middle of the country and have very few trees, we do not need to be concerned about many of the issues discussed in this paper.

Public Health Achievements - Except for Farm Kids? (Blog 5)

This blog covers some of the aspects of “The 10 Greatest Public Health Achievements - United States 2000-2010” according to the CDC.

           

As the title of the article suggests, it summarizes the ten significant changes in public health. There are impressive decreases in pneumococcal conjugated, hepatitis A and B, as well as varicella due to vaccines. State and local public have improved in controlling infectious diseases while laboratories identify and control spreading of diseases. The government have increased the taxes in order to control tobacco. There is standard screening for babies to identify six disorders. Motor Vehicle Safety has improved by safer vehicles, improved roadways and safer road use. Cardiovascular Disease prevention is done by controlling the causes and earlier screening, similar to what is done for cancer. Due to regulations injuries in the nursing profession, farms (in children) and fishing industry have decreased. Regulations have also prevented childhood lead poisoning. Finally, the public health system has improved its response to cases of bioterrorism and dealing with pandemics. All of these are important improvements.

           

Occupational safety is an issue in my hometown. As an agricultural area, all of the kids work on the family farm. Kids work within their capabilities (as decided by their parents); which are underestimated by policy makers. For example, all farm kids drive while underage. The learner-permit age is 15. When their parents deem them responsible, the kids are allowed to drive on their own (~age 13). But according to the government these kids do not have the skills to drive. (Ironically, the dangerous drivers are kids who didn’t grow up driving.) Parents know their child’s capabilities (like their ability to drive) better than people who have never met the kids. The current premier, a farmer, was taken to task by urban opposition politicians for letting his pre-teen kids drive… the urbanites badly lost that PR battle. Yes, children have accidents when working on a farm but so do adults. A neighbouring farmer almost lost his hand, while cleaning out a hay bailer. No one denies that there is a risk to farming but realistically putting new guidelines is not going to change farmers’ behaviour – look at all the underage drivers.

           

Another issue discussed that is important is the increase of taxes on tobacco. Getting cigarettes in high school was really easy to do (or so I’m told). Kids had to pay a ‘risk charge’ (for the risk the adult seller faced) on top of the cost of the actual cigarettes. When the government increased the taxes on cigarettes, prices soared – making smoking too expensive for most teenagers in my school. This prevented quite a few potential addictions.

           

One of the more pressing issues we face is obesity. This problem affects the rest of the healthcare system and thus is important to everyone. According to Health Canada the risks of obesity include: hypertension, high blood pressure, heart disease, type 2 diabetes, etc. Many people are obese because junk food is cheaper than healthy food – ensuring that people have access to healthy food would be a step. Another is changing the public’s mindset. In regards to child obesity, parents control their children and without their effort their children are more likely to become obese. However, there is no specific way to solve this problem.

Access to Healthcare (Blog 4)

This blog briefly analyzes of the access to healthcare and innovations that are occurring in America.

The Dartmouth Atlas Project went on for 20 years to evaluate hospitals and physicians in various regions. Their research has lead to the improvement in healthcare efficiency and effectiveness. (http://www.dartmouthatlas.org/tools/)

Whether healthcare is a right or a privilege is at the centre of the healthcare debate in America. According to the Universal Declaration of Human Rights as agreed upon by the United Nations, Article 25 states: “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care…” (http://www.un.org/en/documents/udhr/) By that definition healthcare is a right but what is at issue is the definition of “adequate” care. In the United States no emergency room is allowed to turn away any patient regardless of their ability to pay. In Canada, all healthcare is covered by the government, with exceptions of some prescriptions. However if we look at the Democratic Republic of Congo (DRC), their version of healthcare, by our standards, is horrendous. Even though we from the West are less than impressed (to put it politely) with their healthcare, the locals are happy with it – it is better than having none. To be blunt, no matter how bad we think the healthcare that the poor here receive, it is amazing compared to the standards of “adequate” care elsewhere.

There were various innovations that are being done within the system. I like how doctors have to answer emails and phone calls, despite the fact that they do not get paid to do so. That along with planning with patients and using computers to easily look at a patient’s history makes patient care very individualized. Doctors may have to spend more time with their patients but in the long run, the system will make doctor visits more productive and will be more efficient. Cost-cutting is also very helpful for patients.

An interesting innovation is shared-decision making. While I agree that the patient must have a voice in their treatment, sometimes the patient does not fully understand what is occurring. Despite explaining and doing research on the issues, patients may not get it. My friend, “Amanda”, and her family have spent countless hours researching epilepsy: treatments, side-effects, consequences and possibilities that could improve her situation. Despite this, her neurologist knows that ‘x’ will not work because of what he has seen with numerous of his patients. Also, medications list a lot of side-effects (in case the manufacturer is sued) but very few of them are important/common. Obviously a doctor is not going to do something without the patients consent but sometimes it is best to listen to the doctor’s advice. If you do not want his advice, you can always diagnose and treat yourself.

To a certain extent the medical system innovations discussed on the program are similar to aspects of healthcare in Canada. The innovations that are not in effect in Canada are very unlikely to be implemented. There are no incentives for the Canadian doctors to change their practice. There is a serious shortage of doctors, thus there is no difficulty getting/keeping patients. Since there is such a demand for doctors, there is no reason for there to be any change in the system. The demand for doctors is so high that they even recruit doctors in the Democratic Republic of Congo to work in Canada!