Contagion is a thriller about the outbreak of a deadly virus and how our modern society attempts to deal with it as it evolves as a pandemic levels. The movie starts with the death of "Patient Zero", and it progresses as the disease spreads to a pandemic, showing what medical researchers, public health offices and government agencies do in order to identify the disease and develop a vaccine to stop its spread.
Analyzing the movie from a public health approach was very interesting; it showed how all of the areas of public health that we have studied in class relate to each other. For example, an epidemiology study is carried to trace back the origin of the outbreak, and the development of bio-weapons is thought to be linked to this origin at some point. Risk communication and policy are carried by public offices to contain the spread of the virus, while at the same time surveillance and clinical trials are being carried out in order to develop an effective vaccine.
In epidemiology, an outbreak is defined as the occurrence of infection with a particular disease in a small, localized group, such as the population of a village. The term is used more broadly to refer to an epidemic or pandemic as it spreads more rapidly. Outbreak investigation seeks for the origin of the virus in order to stop its spread, as we saw in the movie when the WHO epidemiologist is sent to the village in China. Isolation refers to the separation of cases for a disease's period of communicability in order to minimize the risk of transmission of the infectious agents to those who might be susceptible, like what they did with Mitch in the movie, being the husband of the first person who died from the virus. As the outbreak develops into an epidemic, absolute restrictions are enforced, and this is what we called a quarantine, which is what happened in the movie when a military quarantine was imposed, preventing everyone from leaving Chicago.
Public Health agencies in the movie could have been better prepared to deal with the outbreak if they had conducted a better risk communication strategy and enforced social order more effectively in order to stop the riots through which the spread of the disease actually increased. The riots could have also been avoided if the authorities had had a more effective and fair food supply systems, which could have been done by having preparedness plans in collaboration with local communities, so that the sources are large and close enough for when the emergency happens.
Thursday, March 29, 2012
Friday, March 16, 2012
Assignment 6: Climate Change and Public Health
Climate change is an issue that keeps on getting more complex and present in our daily lives. Ten years ago talking about climate change was like talking about the apocalypse: something that was eventually going to come but not in our lifetimes. However, strong rains, heat and cold waves, hurricanes, earthquakes and tsunamis are becoming more and more common on the news, and the effects of this nature forces have widely changed the lives of millions of people's and the economical and social structures of many countries.
In 2009 I happened to be in L'Aquila, Italy, when an earthquake of a 6.0 magnitude in the Richer scale destroyed the old medieval town in the rural outskirts of the state of Abruzzo. My family and I were spending the Easter Holidays at my grandmother's house that Spring, and we had the misfortune of living through this natural disaster that completely destroyed the town's historical center and the surrounding villages. Luckily, my grandmother's house remained standing, and we were able to evacuate quickly; but still, the trembling and the images of the walls cracking and my family screaming and running is something that I won't ever forget. I'm writing about this because I noticed in the chart that one of the effects of natural disasters from the public health approach has to do with mental health.
As the years have passed and I have returned to L'Aquila and seen how the city has been progressively reconstructed, I can tell that the effects of the earthquake are still in people's minds and hearts. Those days right after the disaster were horrible, people were very upset, about losing their houses, their city, and some of their friends and family members; and the media didn't make it easier by being alarmist and emotional by telling personal stories on the disaster. I lived through the mental breakdown and the delicate emotional state in which people in the refugee camps and coastline hotels were, and being in Italy didn't help the cause because society there is even more culturally dramatic. For about months, the earthquake was the only thing my grandmother could talk about, and she always ended up crying when telling the story over and over again. I know about marriages that ended because of the tensions and pressures that this issue had over some couples.
Public health institutions could have made this situation better if they had monitored, diagnosed and dealt with the issue of the mental effects. Media content could have been regulated not to be so alarmist, recreation programs for kids in the refugee camps could have been held to distract them from these dramas and psychological help could have been offered in the refugee camps and the coastline hotels were people who had lost their homes where staying for free.
Another example of an essential service of public health professionals in order to deal with climate change events would have been preparation and prevention. Even though an earthquake can't be predicted, Italy is in a seismic zone and people and hospitals should have been better prepared in both material and mental resources for an issue this big.
Regarding to what are public health institutions in my hometown doing in order to prepare people for climate change I sadly need to answer that nothing. If a natural disaster as strong as L'Aquila's earthquake hits us, it would be the end of Caracas because with do not have strong firefighter bodies or a proper civil society structure strong enough to deal with the great material, social, economical and mental damages.
These last couple of years heavy rains have been a huge problem that have caused the displacement of many families who lived in slums and other improper structures that have been literally washed away, and they still have not been placed in other homes. In fact, we didn't even have the resources to set up refugee camps, so these misplaced persons have been staying in government offices that have been closed in order to provide them with a roof.
In 2009 I happened to be in L'Aquila, Italy, when an earthquake of a 6.0 magnitude in the Richer scale destroyed the old medieval town in the rural outskirts of the state of Abruzzo. My family and I were spending the Easter Holidays at my grandmother's house that Spring, and we had the misfortune of living through this natural disaster that completely destroyed the town's historical center and the surrounding villages. Luckily, my grandmother's house remained standing, and we were able to evacuate quickly; but still, the trembling and the images of the walls cracking and my family screaming and running is something that I won't ever forget. I'm writing about this because I noticed in the chart that one of the effects of natural disasters from the public health approach has to do with mental health.
As the years have passed and I have returned to L'Aquila and seen how the city has been progressively reconstructed, I can tell that the effects of the earthquake are still in people's minds and hearts. Those days right after the disaster were horrible, people were very upset, about losing their houses, their city, and some of their friends and family members; and the media didn't make it easier by being alarmist and emotional by telling personal stories on the disaster. I lived through the mental breakdown and the delicate emotional state in which people in the refugee camps and coastline hotels were, and being in Italy didn't help the cause because society there is even more culturally dramatic. For about months, the earthquake was the only thing my grandmother could talk about, and she always ended up crying when telling the story over and over again. I know about marriages that ended because of the tensions and pressures that this issue had over some couples.
Public health institutions could have made this situation better if they had monitored, diagnosed and dealt with the issue of the mental effects. Media content could have been regulated not to be so alarmist, recreation programs for kids in the refugee camps could have been held to distract them from these dramas and psychological help could have been offered in the refugee camps and the coastline hotels were people who had lost their homes where staying for free.
Another example of an essential service of public health professionals in order to deal with climate change events would have been preparation and prevention. Even though an earthquake can't be predicted, Italy is in a seismic zone and people and hospitals should have been better prepared in both material and mental resources for an issue this big.
Regarding to what are public health institutions in my hometown doing in order to prepare people for climate change I sadly need to answer that nothing. If a natural disaster as strong as L'Aquila's earthquake hits us, it would be the end of Caracas because with do not have strong firefighter bodies or a proper civil society structure strong enough to deal with the great material, social, economical and mental damages.
These last couple of years heavy rains have been a huge problem that have caused the displacement of many families who lived in slums and other improper structures that have been literally washed away, and they still have not been placed in other homes. In fact, we didn't even have the resources to set up refugee camps, so these misplaced persons have been staying in government offices that have been closed in order to provide them with a roof.
Thursday, March 8, 2012
Assignment 5: The 10 Greatest Public Health Achievments
During the past century, life expectancy and wealth not only increased notably in the US, but all around the world. In the early 1900s life expectancy in the modern Western democracies was around 40 years old, and nowadays it is almost the double. This amazing rise in living standards in just a hundred years was due to the great advancements in Public Health, especially in sanitation, water filtration and vaccine development.
The first decade of the 21st century had different, and still notable, achievements in Public Health, which are discussed in this article by the CDC. These achievements can be summarized in vaccine preventable diseases, prevention and control of infectious diseases, smoking bans, healthier mothers and babies, motor vehicle safety, cardiovascular disease preventions, safer workplaces, lead poisoning prevention and public health preparedness and response.
The context in which societies are living is what determines what it is needed to make their lives healthier and better. As we can see, in earlier centuries the greatest health related problems were due to the lack of sanitation and medical resources; but after the 20th century, most of the health problems we're facing have to do with the new ways and habits that we have been able to incorporate in our lives because of the growth of wealth and technological advances that we were able to achieve as soon as we were free from our previous problems. Take for example health problems derived from smoking; injuries from car accidents or firearms; the easier spread of epidemics, due to globalization and modern means of transportation that make traveling easier; heart problems, diabetes and obesity, due to the change in our diets because of the increasing sugars and carbs with all the new "industrialized food system"; childhood lead poisoning due to industrial pollution; and even the fear of bioterrorism, and our ability to respond to it, are some of the biggest health problems we now face.
For this reason, I consider that the greatest health achievements of the next ten years will have to deal with these great problems we have created in the last ten years: environment degradation, increasing incidence of carcinogens in our daily lives, hard access to natural and healthy foods and the development of biological weapons. In my opinion, solving these problems will have to do both with policy and advocacy (environmental laws, food regulations, and national security) and technological/medical advances (development of sustainable agriculture that can produce enough resources for the increasing population, alternate methods that can reduce the incidence of carcinogens, and development of vaccines for the new diseases).
The first decade of the 21st century had different, and still notable, achievements in Public Health, which are discussed in this article by the CDC. These achievements can be summarized in vaccine preventable diseases, prevention and control of infectious diseases, smoking bans, healthier mothers and babies, motor vehicle safety, cardiovascular disease preventions, safer workplaces, lead poisoning prevention and public health preparedness and response.
The context in which societies are living is what determines what it is needed to make their lives healthier and better. As we can see, in earlier centuries the greatest health related problems were due to the lack of sanitation and medical resources; but after the 20th century, most of the health problems we're facing have to do with the new ways and habits that we have been able to incorporate in our lives because of the growth of wealth and technological advances that we were able to achieve as soon as we were free from our previous problems. Take for example health problems derived from smoking; injuries from car accidents or firearms; the easier spread of epidemics, due to globalization and modern means of transportation that make traveling easier; heart problems, diabetes and obesity, due to the change in our diets because of the increasing sugars and carbs with all the new "industrialized food system"; childhood lead poisoning due to industrial pollution; and even the fear of bioterrorism, and our ability to respond to it, are some of the biggest health problems we now face.
For this reason, I consider that the greatest health achievements of the next ten years will have to deal with these great problems we have created in the last ten years: environment degradation, increasing incidence of carcinogens in our daily lives, hard access to natural and healthy foods and the development of biological weapons. In my opinion, solving these problems will have to do both with policy and advocacy (environmental laws, food regulations, and national security) and technological/medical advances (development of sustainable agriculture that can produce enough resources for the increasing population, alternate methods that can reduce the incidence of carcinogens, and development of vaccines for the new diseases).
Saturday, March 3, 2012
Assignment 4: Healthcare System
The Dartmouth Atlas Project is a study on how the quality and costs of healthcare vary in different geographic regions of the country; and the purpose of this research is to determine which are the most effective healthcare systems that "can save the most lives at the lower costs".
In the beginning of the video they explain how supply drives demand in order to show how the increase in health services has made the costs of healthcare rise even higher. It has gotten to the point where the system pays for the services, so providers don't care if the patients need the services and the patients don't question what kind of healthcare are they receiving because they're not paying for it directly. This is how they found out that communities like those in Grand Junction Colorado and Seattle proved to have the best healthcare because of the preventive and cooperative nature of their systems, where all doctors get paid the same fees for given services so that they can take the time to evaluate their patients holistically and work out a plan with them to reduce their number of visits to the hospital, lowering costs and at the same time increasing the number of patients that they can attend.
If we live or die depends on our health, and having these high stakes at the table makes access to healthcare a right rather than a privilege . I understand that health services must be retributed and that they are expensieve because of their complexity, which is why I believe that communities need to work together in order to promote health and work out a system that assures that everyone has the same opportunities to be healthy and have a lifestyle in which their basic needs can be satisfied.
I found really impressive how the Group Health Cooperative in Seattle uses technology in order to keep electronic records in order to tell what services are needed and which ones are not so that the system can be more effective. They take information with previous patients with similar conditions to draw conclussions and come up with a methodology that makes diagnosis much more easier, so therefore treatment is less extensieve, more effective and less expensieve.
In Venezuela (which is where I am from) the system is very different. Healthcare is not as expensieve as it is in the United States, and still most people are insured by their employers or private companies. In the worst case scenario middle income families can always afford to pay for it directly from their pockets, and they are free clinics for the poorest sectors. However, the quality is not the same, mostly due to the lack of technology and to the fact that the population is too large for such a small number of facilities and providers, which makes the system ineffective. People wait for more than three hours to see a doctor (even with an appointment), and sometimes the doctor doesn't even have time to see them. But once they are attended, the patient does receive a holistic examination and an appropriate treatment. The price of pharmaceuticals is continuously increasing and the poorest families can't afford them sometimes, but this is because of the raging inflation that is taking over everything, not just medications.
In the beginning of the video they explain how supply drives demand in order to show how the increase in health services has made the costs of healthcare rise even higher. It has gotten to the point where the system pays for the services, so providers don't care if the patients need the services and the patients don't question what kind of healthcare are they receiving because they're not paying for it directly. This is how they found out that communities like those in Grand Junction Colorado and Seattle proved to have the best healthcare because of the preventive and cooperative nature of their systems, where all doctors get paid the same fees for given services so that they can take the time to evaluate their patients holistically and work out a plan with them to reduce their number of visits to the hospital, lowering costs and at the same time increasing the number of patients that they can attend.
If we live or die depends on our health, and having these high stakes at the table makes access to healthcare a right rather than a privilege . I understand that health services must be retributed and that they are expensieve because of their complexity, which is why I believe that communities need to work together in order to promote health and work out a system that assures that everyone has the same opportunities to be healthy and have a lifestyle in which their basic needs can be satisfied.
I found really impressive how the Group Health Cooperative in Seattle uses technology in order to keep electronic records in order to tell what services are needed and which ones are not so that the system can be more effective. They take information with previous patients with similar conditions to draw conclussions and come up with a methodology that makes diagnosis much more easier, so therefore treatment is less extensieve, more effective and less expensieve.
In Venezuela (which is where I am from) the system is very different. Healthcare is not as expensieve as it is in the United States, and still most people are insured by their employers or private companies. In the worst case scenario middle income families can always afford to pay for it directly from their pockets, and they are free clinics for the poorest sectors. However, the quality is not the same, mostly due to the lack of technology and to the fact that the population is too large for such a small number of facilities and providers, which makes the system ineffective. People wait for more than three hours to see a doctor (even with an appointment), and sometimes the doctor doesn't even have time to see them. But once they are attended, the patient does receive a holistic examination and an appropriate treatment. The price of pharmaceuticals is continuously increasing and the poorest families can't afford them sometimes, but this is because of the raging inflation that is taking over everything, not just medications.
Friday, February 24, 2012
Assignment 3: Vaccine Wars
The Frontline Special on "Vaccine Wars" had to do with the great benefits of vaccination to public health, explaining why the acquisition of vaccines is a social responsibility that should be enforced by institutions rather than just a parental choice. In order to support this argument the concept of "herd immunity" is introduced to explain how the vaccination of a significant portion of the population provides protection to unprotected individuals, especially those who cannot receive the vaccine due to the vulnerability of their inmune system because of their age or the presence of another illness.
As I was watching the video I could not help to think about the mumps outbreak that happened in my little cousin's school a couple of years ago. Around 15 kids contracted the disease, including my little cousin, and he developed the symptoms about a week later when he was already in summer vacation in North Carolina. Since he contracted the disease in his school in Venezuela, it took a while for the doctors in North Carolina to diagnose it (since the disease is not as common in the United States as it is in Venezuela).
After the doctors in North Carolina finally found out that he had mumps, my cousin was quarantined, in order to stop a further spread of the disease. He and most of the kids who got the disease in his school in Venezuela were vaccinated, which protected them from the possibility of the development of a much more serious condition. The idea of "herd immunity" made me think about them contracting the disease from a kid who didn't get the mumps shot, which proves how this facilitates the spread of a disease, even outside a country's boundaries. This is why I consider that requiring immunizations is an important policy for public health, which is why awareness on this matter should be raised so that parents can understand that this is an issue that goes beyond a parenting choice.
Another of the things that impressed me the most about the documentary is the power that internet and media have over society. The "free flow" of information can be overwhelming, especially if it is alarmist; and I understand how not being able to tell what is true and what is not can be scary, which is probably why people in today's world have grown to be very skeptical or, on the other extreme, very easily mislead into false information. This is why flawed research, like the one that linked autism with the MMR shot, has caused so much controversy on why children should not receive the recommended immunizations.
The strong support that has grown for this public misconception has also been supported by the little information we have on autism, which is why I think that further studies on these conditions (and any other ones that can possibly be related as "side effects") should be encouraged in order to have stronger evidence to convince people that their fears for vaccination are not real. People must also be educated to recognize the legitimacy of primary sources, like well known medical journals and institutions that have reliable data, like the CDC. But the most effective policy to increase vaccination rates would be to limit the reasons for exemptions in immunization only to medical conditions, and to start public health campaigns in local communities that offer immunizations for free.
However, this would be a very difficult policy to implement due to philosophical or religious reasons for which parents don't want their children to receive the required shots, but I believe that if the institutions commence with strong actions to raise awareness of the importance of vaccination for public health and the availability of immunizations and information on them, some advancement can be made in order to reduce the number of those who oppose mandatory immunization.
As I was watching the video I could not help to think about the mumps outbreak that happened in my little cousin's school a couple of years ago. Around 15 kids contracted the disease, including my little cousin, and he developed the symptoms about a week later when he was already in summer vacation in North Carolina. Since he contracted the disease in his school in Venezuela, it took a while for the doctors in North Carolina to diagnose it (since the disease is not as common in the United States as it is in Venezuela).
After the doctors in North Carolina finally found out that he had mumps, my cousin was quarantined, in order to stop a further spread of the disease. He and most of the kids who got the disease in his school in Venezuela were vaccinated, which protected them from the possibility of the development of a much more serious condition. The idea of "herd immunity" made me think about them contracting the disease from a kid who didn't get the mumps shot, which proves how this facilitates the spread of a disease, even outside a country's boundaries. This is why I consider that requiring immunizations is an important policy for public health, which is why awareness on this matter should be raised so that parents can understand that this is an issue that goes beyond a parenting choice.
Another of the things that impressed me the most about the documentary is the power that internet and media have over society. The "free flow" of information can be overwhelming, especially if it is alarmist; and I understand how not being able to tell what is true and what is not can be scary, which is probably why people in today's world have grown to be very skeptical or, on the other extreme, very easily mislead into false information. This is why flawed research, like the one that linked autism with the MMR shot, has caused so much controversy on why children should not receive the recommended immunizations.
The strong support that has grown for this public misconception has also been supported by the little information we have on autism, which is why I think that further studies on these conditions (and any other ones that can possibly be related as "side effects") should be encouraged in order to have stronger evidence to convince people that their fears for vaccination are not real. People must also be educated to recognize the legitimacy of primary sources, like well known medical journals and institutions that have reliable data, like the CDC. But the most effective policy to increase vaccination rates would be to limit the reasons for exemptions in immunization only to medical conditions, and to start public health campaigns in local communities that offer immunizations for free.
However, this would be a very difficult policy to implement due to philosophical or religious reasons for which parents don't want their children to receive the required shots, but I believe that if the institutions commence with strong actions to raise awareness of the importance of vaccination for public health and the availability of immunizations and information on them, some advancement can be made in order to reduce the number of those who oppose mandatory immunization.
Friday, February 17, 2012
Assignment 2: Second-hand Smoking and Lung Cancer
A study conducted in women in Japan proved that non-smoking wives of heavy smokers have a higher risk of lung cancer. About 92,000 non-smoking wives aged 40 and above were followed up for 14 years (1966-1979), and results showed that the risk was greater in agricultural families when the husbands were 40-59 years old. The husbands' smoking habits did not affect their wives' risks dying of other types of cancer; and their was just a small increase in the risks of the wives dying of heart diseases or developing ephysema and asthma. How much did the husbands smoke, their drinking habits and the environment in which the family was set were variables considered in the study. The results were published in The British Medical Journal on January 1981.
The study is an example of a cohort study, since it was done with a large number of subjects and over an extended period of time. It dealt with some confounding variables (i.e rural vs. urban environments, age groups, drinking habits of the husbands) and it also considered the dose-response relationship between exposure and risk of disease.
In my opinion, asserting that second hand smoking is a "cause of lung cancer" rather than a "factor of risk" is a very strong accusation, especially because of unavoidable bias in the control group that might have lead to associating variables by chance.
In this particular case, bias might not been a problem in reporting, because the population was interviewed and followed by establishing a record linkage system between the risk-factor records and a residence list obtained by special yearly census, with death certificates. However, I do see bias as a big problem regarding the controlled variables in the group of non-smoker women. The variables were set upon what their husbands were doing, but what about what the women were doing? Were they drinking? Were they doing exercise? What were their diets like? Did other people who they were around continuously smoked? All of these confounding variables are not mentioned in the study, and that makes me question the certainty of the results because of a bias selection of control groups.
Also, I find incredible how passive smoking is associated with a disease as complex as cancer and not with the obvious asthma that comes with breathing contaminated air. The weak association between the exposure and disease and the lack of a biological explanation that addresses this association also takes away from this study credibility and reliability.
When we are analyzing a study of such a complex nature and large dimension it is important to recognize the limits of epidemiological research. For the most part, this epidemiologic study no matter how well designed it was to avoid error, it cannot prove cause and effect because of its susceptibility to many sources of error. As it was proven in this study, confounding factors may influence results, suggesting an association that cannot be entirely proved; and bias might have also played its part in the selection of control cases. Asserting the wrong conclusions could have enormous consequences, so one must always be skeptical on reading on these studies and very careful and perfectionist when conducting one.
Wednesday, February 8, 2012
Hans Rosling’s 200 Countries, 200 Years, 4 Minutes - The Joy of Stats
Hans Rosling presents his data very dynamically. It reminded me of what Ms. Dana Sleicher said on Tuesday about Public Health being ever expanding and in continuous movement. It also shows what we have been talking this past week about how the improvements in Public Health in the beginning of the 20th century have changed life so broadly.
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