Community Based Public Health

Rubella elimination in the Americas and the Vaccine effectiveness argument

Vaccines are arguably the most successful public health intervention of the 20th Century. The successes that have been noted in reducing disease and deaths are immeasurable and hopefully there are many more successes to come with the current work being done with Polio. Within the last 15-20 years, the anti-vaccine movement has become a major player not only in debating the effectiveness and safety of vaccines, they have become an entrenched force that has driven down the community (Herd) effectiveness of vaccine through their non-compliance with vaccination standards. Many of their main arguments are invalid (autism/vaccine link) and their stubbornness to comply claiming personal exemptions bring harm to children. Each position previously mentioned is one in the same since many anti-vaxers forgo vaccines because of a personal belief and/or their rights are being infringed upon by a paternalistic governmental force.

This week, it was reported that Rubella has been eliminated from the Americas. This is highly historic as the efforts and gains made in the Americas can begin the worldwide elimination of Rubella worldwide. To what can we thank for this development? It would have to be the MMR vaccine! Through the use of the MMR vaccine, we have the power to eliminate vaccine prevenatble disease worldwide to end major suffering. Vaccine preventable diseases can be eliminated from out world and bring about a higher standard of health, improving life expectancy, reducing infant and child mortality due to these diseases and have a major effect on health costs.

Preventative health from a vaccination standpoint makes sense as we look not only to reduce disease burden, but we also want to reduce health costs for treatments later in life. Vaccination is an investment, there are costs to vaccination but those paying the costs must see these costs as investments in individual and community health. These investments MUST be made at the beginning of life to control health costs at the end of life. More investment at the front end keeps health costs low, improves overall coverage for all and can allow for coverage more more acute and complex health issues later in life. There is no excuse for not wanting to vaccinate when we can see that their effects on disease burden are obvious!

The tug-of-war between pro-vaccine and anti-vaccine movements continue. With smallpox declared eradicated 35 years ago and two other diseases heading towards eradication, another check can be placed in the column for the pro-vaccine movement while the foundation of the anti-vaccine movement suffers another blow.

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HIV Epidemic in Southern Indiana: Why the social aspects of disease need to be addressed

Last week, the CDC declared a HIV epidemic in Scott County Indiana. As early as January, there were seven noted cases of HIV in an area that suffers from high levels of poverty and injection drug use. Both poverty and drug use as social factors are very commonly seen in many populations and drive HIV rates. It has been known for many years that sharing needles with someone who is HIV positive is one major means of contracting the virus. What we have not done as a society is to address head on the issues that drive infection rates. Why have we not established needle exchanges to provide clean needles for addicts?

Gov. Mike Pence (R-Indiana) with advice from the CDC team in Scott County agreed to allow temporary needle exchanges to slow the infection rates. What Gov. Pence is not doing is allowing for the establishment of exchanges for a longer term. For Gov. Pence and many on the political right, needle exchanges are a problematic issue. Saying “needle exchange” in politically right leaning circles in akin to saying that you support illicit dug use. The British government during the term of Margaret Thatcher instituted needle exchange programs for the good of the health of the United Kingdom. The decision although politically divisive, saved lives and it helped to reduce HIV infection rates among IV drug users dramatically. To me, this issue is a no brainer. Short-term needle exchange programs will be helpful in Scott County, but in order to not repeat an epidemic of this magnitude or worse in an area where poverty drives a culture where sexual networks can form and the drug culture is rampant. Political views override the best interests of many in this country.

Needle exchanges, while allowing for addicts to stay safe and reduce the chances of contracting HIV doesn’t halt the use of drugs. What if we could offer rehabilitation while these exchanges operate? It would stand to reason that there are factors which lead individuals to drug use, during an exchange while we are offering them protection against reusing/sharing used needles we could also  develop and expand resources to help individuals break the addiction cycle. But if we break teh cycle of addiction by dealing with all of the underlying factors associated with a particular person’s addictions, then how do they continue on a clean path when poverty continues to be prevalent and pathological in their community. I do not have the answers on how poverty can be conquered, but it starts with opportunity. So many of our politicians say that they are pro-USA for jobs and manufacturing but they continue to sanction loopholes for corporations that ship jobs to other countries. Poverty persists because those who want to work and want to make a LIVING WAGE cannot do so because of the lack of semi-skilled work. Not every job should require a college degree but with the right training, we can provide work that gives every impoverished American the ability to contribute to all aspects of our economy. HIV is not just about a disease, it is very much about the factors that lead to acquiring the disease. Until we see that diseases such as HIV, TB and neglected tropical diseases are intimately linked with poverty, we will continue to struggle with controlling or eradicating their deadly effects from our world.

Bacteria: Friend, Foe or all of the above?

Remember the episode of the Cosby Show, when Rudy catches a cold and Cliff has to take care of her? Cliff’s characterization of what made Rudy sick is probably a common experience and is most likely the first lesson we received about “germs” and their effects. Bacteria have and continue to get a bad rap as only a cause of disease. But did you know that bacteria have positive effects on the lives of humans and other higher organisms? I always begin my beneficial effects of bacteria lecture by posing that question to my students. The most common reaction to my question is disbelief, as if I had just shattered everything they ever learned. The look on their faces says it all: “Bacteria can be useful?” And I commence to explain how this is possible. I think that the reaction that I receive on a consistent basis from students and even from the public at large, that bacteria are all bad, period. I am not saying that the perception is all wrong but the majority of people have it half right and only focus on the ill-effects of bacteria. What are the benefits of bacteria and how do these benefits impact human life?

The relationship between humans and bacteria when beneficial is characterized as commensal or a relationship where neither human nor bacteria is harmed. Bacteria found in and on humans grow and survive with no problems and begin to engage in biological activities which assist human life. One of the most important activities bacteria engage in is protection and immunity from disease. Human skin is the largest and most important body organ. Skin protects muscle, bone and tissue from damage due to everyday movement, sunlight and disease. In addition to the oils naturally secreted by the skin and sweat which contains an enzyme that assists in killing pathogenic or disease causing bacteria, bacterial cells occupy the skin in large numbers. Although bacteria have no problem growing and surviving on the skin, skin is a very poor growth medium because it has a very low pH and is very dry. A large number of bacterial species occupy the skin and maintain a protective barrier against disease causing bacteria. This is only the first line of defense, a disease causing bacteria that enters the skin will trigger an immune reaction which begins a vigorous, second line of defense in fighting off a potential infection.

The human digestive system also benefits greatly from the activity of bacteria. When food is taken in and digested, only a certain amount of nutrients can be taken up from the food by the body. The body needs and requires a number of vitamins, minerals, proteins and carbohydrates in order to maintain function and growth. Many of these are available in food directly while others are available but are not able to be used unless they are converted into another form. Bacteria act as the means by which some of these “hidden” nutrients and vitamins are extracted and put into use by the body. Think of bacteria as “factories” which help to break down food, take in the vitamins and nutrients in their inactive form and convert them to the active form that can be taken in and used by humans.

Within the last 15-20 years, there has been a steady increase in the availability of probiotics, supplements of bacterial cultures that when used properly can provide health benefits. Probiotics are not new as they were first identified in the early 20th Century as a method to assist in maintainance of balance between beneficial and harmful bacteria. Further research has shown that probiotics can also help with digestive ailments such as Irritable Bowel Syndrome (IBS), Diarrhea and reduce the chances of ulcers caused by a bacteria named Helicobacter pylori (H. pylori). Research into the use of probiotics have been very positive. Many people benefit greatly from their use. There are issues of safety which have not been fully studied and mild side effects do occur such as gas, bloating or a mild bacterial infection. Probiotics and their use illustrate the point very effectively that maintaining a balance in the normal types of bacteria that live in the digestive system with those that could cause harm is a very important function. When harmful bacteria are not kept in check by equally beneficial bacteria, the effects on human life could potentially be fatal.

Bacterial flora balance can increase or decrease due to many factors. Health is a major factor and can change as one becomes older and disease becomes prevalent. If antibiotics are needed, the proper use of antibiotics is key. If antibiotics are used when they are not needed, bacteria could become resistant and harder to treat. Antibiotic resistance is fast becoming a major problem worldwide due to the misuse of antibiotics when they are not needed or having an antibiotic prescribed when a viral infection is diagnosed. Bacteria and viruses are two completely different life forms which require different types of drugs in order to attack and kill them. Antibiotics will not attack viruses but instead will attack the bacteria that is it specified to kill and leave an unbalanced bacterial flora which could cause disease. Other factors include diet, hormonal state and even personal hygiene. Finally, genetic factors can have an effect on the rise and fall of bacterial levels.

Life in general is based on very fine balance in many respects from bacterial levels, to pH (Acid-Base balance). As illustrated in this article, having the right balance of beneficial bacteria has a major role in assisting us in maintaining our health. Bacteria are versatile organisms that reproduce quickly, adapt and evolve far faster than most other living species on earth. We benefit from that versatility when it comes to the role that bacteria play in our body’s defense and digestion. Unfortunately we succumb to that same versatility when we are infected by bacteria. So now, think of bacteria as a frienemy, it can be good at times or it can be bad.

Reference:

An Introduction to Probiotics. National Center for Complementary and Alternative Medicine. Website accessed August 30, 2009.

Where Public Health and Biology Meet

Hello out there, and thanks for reading. The purpose of this blog is to present a range of topics relating to Public Health, Science and Health Policy. How many articles or news programs do you watch that actually breakdown the substance of the issue into basic bits of information for you to understand? Probably very few. Also, as biased as the news is becoming it is a miracle that any of us get any clear, concise and non-opinionated information anymore. That is where this blog comes in, presenting information in what I hope will be concise and informative (and hopefully with no opinions). Why? So you can form your own opinion or just be more informed and as the title states have a wealth of information to help you become a healthier you.

What do I ask of you:

1. If you read, please try to comment or ask a question. In fact if you have any topics of interest I will try my level best to address them. (More on that in a minute)

2. Discuss here or with others. Information is a powerful tool and my goal is to educate as many people as possible. My belief is “each one, teach one” or as they like to say on Sportscenter, “Thanks for sharing the knowledge”.

3. Tell a friend. I hope to make this blog interesting to read in simple language and as I said previously with as less opinion as possible. This is a work in progress and I hope you will read along as this blog becomes more refined.

Now that you know the areas of interest (and they are not totallyall my interest areas but they all cover alot of ground) that gives you an idea of the scope of what I would like to share with all of you. However, I would like to also cover basics in Biology and Science in addition to what is going on in the world of public health. Please let me know if there is a topic that interests you and I will give it my best to outline the topic in as basic a manner as possible. I hope to expand this blog into a larger site and possibly use other avenues to get the word out about this blog so stay tuned.