Andrew Siegel MD 2/8/2020
Coronavirus Update:
- As of this morning, deaths in China have surpassed 720 and the number of documented infections rose above 34,000. The first American citizen in Wuhan died because of the coronavirus infection.
- Royal Caribbean and Norwegian Cruise Lines barred people from their cruise ships who hold passports from China, Hong Kong and Macau.
- Secretary of Health and Human Services Alex Azar: “The coronavirus poses a public health emergency in the United States.”
The field of public health being thrust into the spotlight is an opportune segue into an entry on the discipline, one that is often under-appreciated, yet vitally important to the health of the population as well as that of the individual.
United State Public Health Services seal
“Far more than any other lifestyle change or medical intervention, clean water and working sanitation systems have led to longer and healthier lives the world over.”
“Public health is the science of not only preventing contagious disease, but also of prolonging life and promoting physical health and efficiency.”
–CEA Winslow (1923)
“People whose diseases are prevented as opposed to cured may never really appreciate what has been done for them. Zimmerman’s law: Nobody notices when things go right.”
–Walter M. Bortz, II, M.D. (Next Medicine: The Science and Civics of Health)
“Vaccines are the single most effective medical intervention in human history in terms of saving and extending life spans… We are privileged to live in an age in which we can protect ourselves and our children from potentially deadly diseases.”
–David A. Sinclair, PhD (Lifespan: Why We Age– and Why We Don’t Have To)
Physicians interact with and care for individual patients, most of whom are genuinely appreciative when their problems are diagnosed and treated. A successful diagnosis and cure/improvement of the problem is rewarding and gratifying for patient as well as doctor.
On the other hand, those who work in the field of public health deal with populations as opposed to individual patients. Health achievements directed at entire populations are equally, if not more capable of improving an individual’s health than their interactions with their personal physicians. However, public health advances are often not appreciated, nor for that matter even considered, simply because it is difficult to be grateful for prevention of problems that never have a chance to manifest. Public health practitioners often play second fiddle to those physicians who care for individual patients, unfairly so.
U.S. life expectancy advanced from 47 years to 77 years in the century from 1900-2000. Key public health measures and developments responsible for this dramatic change were in sanitation, vaccination, antibiotics, regulation (tobacco, motor vehicle safety, occupational safety, lead poisoning prevention, etc.), health education and most recently cardiovascular disease, diabetes, and cancer preventive measures.
A Brief History of Public Health
Dreaded epidemics– including plague, cholera and smallpox– have wreaked havoc on large populations. By the 18th century, isolation of the ill and quarantine of the exposed were adopted as public health measures to restrain and contain epidemics. In the late 1700s, Edward Jenner developed the world’s first vaccine, protecting the public from smallpox by using cowpox injections, a related virus.
The 19th century was the century of sanitary awakening with the realization that filth and contamination were the cause and vector of disease transmission. The sanitation problem stemmed from urbanization and industrialization engendering filthy and deplorable environmental conditions, particularly in working class, crowded areas. Smallpox, cholera, typhoid and tuberculosis were rampant. The adoption of hygiene, cleanliness, improving the common environment and the development of sanitation resulted in saving more lives than any other measure. Prevention rather than disease control became the mantra. W.T. Sedgwick in 1891 identified fecal bacteria in the water as a source of typhoid fever and developed the first sewage treatments. The late 1800s witnessed the proliferation of state and local health department labs that enabled improved sanitation through the detection and control of bacteria in water systems. Edwin Chadwick in London popularized the concept of building a drainage system to remove sewage and waste.
In the latter 19th century, bacteriology came into fruition. Louis Pasteur developed the world’s second vaccine, preventing rabies by using dried spinal cords from infected rabbits. Pasteur also showed that anthrax was caused by a bacterium and developed immunization against it. Subsequently, the bacterial sources were discovered for tuberculosis, diphtheria, typhoid, and yellow fever. For the first time, it was realized that any infection had a single and specific cause. This engendered a variety of immunizations, and in conjunction with water purification techniques, led to the prevention of disease and limitations on the spread of disease. Theobald Smith established the principle of using biological products to create immunity to specific diseases and developed vaccines and antitoxins for smallpox, meningitis, tuberculosis and typhoid.
In the first half of the 20th century, state and local public health departments, school health clinics, and tuberculosis clinics proliferated. There was an increasing focus on health promotion as opposed to disease prevention. In 1906, the Food and Drug Act was passed by Congress, placing restraints on the manufacture, labeling and sale of food and medicines, creating safer and healthier foods and medications. In 1912, the US Public Health Service was created, directed by the surgeon general. In 1930 the National Institute of Health (NIH) was created and the Center for Disease Control (CDC) was established during World War II. The 20th century can be thought of as the century of medicine with the development of antibiotics, more vaccines, transfusions, chemotherapy, etc. Additionally, the 1900s witnessed the institution of measures to promote motor vehicle safety, workplace safety, fluoridation of drinking water to prevent cavities and a reduction in tobacco use.
In the 1950s, there were four vaccines: diphtheria-tetanus-pertussis (DTP) and smallpox. About 40% of United States children were immunized, a rate similar to that in many developing countries today. In the 1970s, there were seven vaccines: DTP, measles-month-rubella (MMR), and polio. The immunization rate was approximately 70%. In the 1990s there were ten vaccines: DTaP (including the new pertussis vaccine), MMR, polio, hemophilus influenza B, hepatitis B, and chickenpox. Immunization rates rose from 70 to 90% and several diseases were completely or virtually eliminated.
By the end of the first decade of the 21st century, the Center for Disease Control immunization policy had established a vaccination schedule to target seventeen diseases, adding rotavirus (causes gastroenteritis), meningococcus (causes meningitis), influenza, human papilloma virus (HPV—causes warts and numerous cancers), pneumococcus (causes pneumonia), hepatitis A, and shingles (herpes zoster). Pneumococcus and rotavirus vaccination have had a particularly striking impact.
Taxes, legislation prohibiting smoking, restrictions on youth access and graphic warning labels were significant factors that decreased the prevalence of tobacco use. Unfortunately, the recent popularity of e-cigarettes has raised concerns that vaping is serving as an entry nicotine product.
Bottom Line: Public health science has been a victim of its own success, since most people don’t appreciate– nor even consider–diseases that we never get. We truly should be thankful for, beholden to and appreciative of public health physicians, public health scientists and other public health care workers who are responsible for measures and advances that have improved both our longevity and quantity of our lives.
Wishing you the best of health,
A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”: www.HealthDoc13.WordPress.com
Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery. He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community. He is a urologist at New Jersey Urology, the largest urology practice in the United States. His latest book is Prostate Cancer 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families.
Video trailer for Prostate Cancer 20/20
Preview of Prostate Cancer 20/20
Andrew Siegel MD Amazon author page
Prostate Cancer 20/20 on Apple iBooks
PROSTATE CANCER 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families is now on sale at Audible, iTunes and Amazon as an audiobook read by the author (just over 6 hours).
Dr. Siegel’s other books:
PROMISCUOUS EATING— Understanding and Ending Our Self-Destructive Relationship with Food
MALE PELVIC FITNESS: Optimizing Sexual and Urinary Health
THE KEGEL FIX: Recharging Female Pelvic, Sexual, and Urinary Health
Our Greatest Wealth Is Health 