It’s been said the more things change, the more they stay the same. That seems to be the case with issues arising and affecting population or public health.
The emergence of the public health system largely began over concern for infectious or communicable diseases — those passed from person to person. Early public health interventions occurred long before it was determined that certain germs caused certain specific diseases.
From early human civilization, for example, it was understood that polluted water and lack of proper waste disposal spread communicable diseases. In biblical times, a system of Mosaic laws governed proper hygiene and cleanliness; and it was understood that separating diseased individuals from healthy individuals, such as in the case of leprosy, had merit in stopping or slowing the spread of contagion.
As time went on, society became successful at limiting these disease threats. Concern over communicable diseases was replaced by concern over chronic, non-infectious diseases caused largely by the way we live our lives. New fields of study began helping us understand the role of environment, genetics and lifestyle to new threats such as heart disease, cancer and diabetes. Times changed, but have they?
Every year, we see new and re-emerging infections we either never knew about or had previously thwarted. Even within the jurisdiction that I serve, I see cases of disease we haven’t dealt with in decades, or new cases of disease first diagnosed within the last five years. In each instance, for what are known as “reportable diseases” because they have legal requirements demanding they be reported to higher-level officials and subsequent follow-up, it requires a action by professionals in the medical sector to diagnose, and in the public health sector to track and monitor contacts to stop their spread.
Infections know no boundaries, so careful communication must occur between medical institutions and within and across public health jurisdictions. Just to name a few examples of the more well-known re-emerging infections occurring over the last few decades: multi-drug resistant tuberculosis, West Nile Virus and the 2009 H1N1 influenza. Some of the more well-known emerging infections over the last few decades include Hantavirus, Bovine Spongiform Encephalopathy (otherwise known as “mad cow disease”), Sudden Acute Respiratory Syndrome (SARS), and E. coli.
So when the reports came out earlier this month about a new super bug referred to as CRE (carbapenem-resistant Enterobaceriaceae), my thoughts returned to the earliest beginnings of public health interventions and how this latest emerging infection might be effectively dealt with. The director of the Centers for Disease Control and Prevention, Dr. Thomas Frieden, referred to CRE as “nightmare bacteria that present a triple threat,” resistant to nearly all antibiotics with high mortality rates.
Unfortunately, this new disease threat arrives at a time when our public health system already has been compromised by budget shortfalls. By one report, by 2009, 55 percent of all local health departments had made cuts to important public health programs and almost half had lost key staff. When such diseases affect some remote corner of the world, we are less concerned.
But with the current public health workforce being limited by daunting state fiscal constraints, there is an increasing likelihood of infectious disease spreading much closer to home.
-- Remmert is director of the DeWitt-Piatt County Health Department.