Public health, current issues

Public health is the establishment and maintenance of healthful living conditions for the general population. This goal requires organized effort from all levels of government. Underlying the current concerns in public health are three principle aims of public health efforts. First is the assessment and monitoring of populations, from the community level to the national level, to identify populations who are at risk for whatever health problem is being considered. For example, public health efforts have shown that aboriginals in Canada are especially prone to developing diabetes. The second "plank" of public health is the formulation of policies to deal with the significant problems. Returning to the example, policies and strategies for action are now being formulated to reverse the trend. The third core public health function is to assure that everyone is able to receive adequate and affordable care and disease prevention services.

There are many microbiological threats to public health. In order to maintain the three cores of public health, priorities must be established. In organizations such as the Centers for Disease Control and the World Health Organization , different divisions have been created to address the different concerns. Within each division the particular area of concern, such asfood safety , can be simultaneously addressed at various levels, including basic research, policy development, and public awareness.

In the aftermath of the September 11, 2001, terrorist attacks on targets in the United States, public perception of the health risks of what is commonly known as bioterrorism has been heightened. The ability to transport harmful microorganisms or their products, such as anthrax , through the mail or via dispersal in the air has made clear how vulnerable populations are to attack. Public health agencies have realized that the ability to promptly respond to an incident is critical to any successful containment of the disease causing microbial threat. But the achievement of this response will require a huge effort from many public and private agencies, and will be extremely expensive. For example, it has been estimated that a response to each incident of bioterrorism, real or not, costs on the order of 50,000 dollars. Repeated mobilization of response teams would quickly sap the public health budget, at the cost of other programs. Thus, in the latter years of the twentieth century and the new century, the issue of bioterrorism and how to deal with it in a safe and economically prudent way has become a paramount public health issue.

Another public health issue that has become more important is the emergence of certain microbial diseases. In the emergence category, hemorrhagic diseases of viral origin, such as Ebola and Lassa fever are appearing more frequently. These diseases are terrifying due to their rapid devastation inflicted on the victim of infection, and because treatments are as yet rudimentary. The emergence of such diseases, which seems to be a consequence of man's encroachment on environments that have been largely untouched until now, is a harbinger of things to come. Public health agencies are moving swiftly to understand the nature of these diseases and how to combat them.

Diseases are also re-emerging. Tuberculosis is one example. Diseases such as tuberculosis were once thought to be a thing of the past, due to antibiotics and public health initiatives. Yet, the numbers of people afflicted with such diseases is on the rise. One factor in the re-emergence of certain diseases is the re-acquisition of antibiotic resistance by bacteria . Another factor in the re-emergence of tuberculosis is the sharp increase in the number of immunocompromised individuals that are highly susceptible to tuberculosis, such as those with acquired immune deficiency syndrome (AIDS ). The overuse and incomplete use of antibiotics has also enabled bacteria to develop resistance that can be passed on to subsequent generations. Public health efforts and budgets are being re-directed to issues thought at one time to be dealt with and no longer a concern.

Certain infectious diseases represent another increasingly important public health issue. Just a few decades ago AIDS was more of a curiosity, given its seeming confinement to groups of people who were often marginalized and ostracized. In the past decade, however, it has become clear that AIDS is an all-inclusive disease. Aside from the suffering that the illness inflicts, the costs of care for the increasingly debilitated and dependent patients will constitute a huge drain on health care budgets in the decades to come. As a result, AIDS research to develop an effective vaccine or strategies that prolong the vitality of those infected with the AIDS virus is a major public health issue and priority.

Another public health issue of current importance is chronic bacterial and viral diseases. Conditions like fibromyalgia may have a bacterial or viral cause. The chronic and debilitating Lyme disease certainly has a bacterial cause. Moreover, the increasing use of surgical interventions to enhance the quality of life, with the installation of heart pacemakers, artificial joints, and the use of catheters to deliver and remove fluids from patients, has created conditions conducive for the explosion in the numbers of bacterial infections that result from the colonization of the artificial surfaces. Such bacterial biofilms have now been proven to be the source of infections that persist, sometimes without symptoms, in spite of the use of antibiotics. Such infections can be life threatening, and their numbers are growing. As with the other current public health issues, chronic infections represent both a public health threat and a budget drain.

A final area that has long been a public health concern is the safety of food and water. These have always been susceptible to contamination by bacteria, protozoa and viruses , in particular. With the popularity of prepared foods, the monitoring of foods and their preparation has become both more urgent and more difficult for the limited number of inspectors to do. Water can easily become contaminated. The threat to water has become greater in the past twenty years, because of the increasing encroachment of civilization on natural areas, where the protozoan pathogens Giardia and Cryptosporidium normally live, and because of the appearance of more dangerous bacterial pathogens, in particular Escherichia coli O157:H7. The latter organism is a problem in food as well.

See also Bacteria and bacterial infection; Epidemics and pandemics; Food safety; History of public health; Viruses and responses to viral infection