Step right up, Ladies and Gentlemen, gaze upon what’s new, what’s high tech, what’s the latest in Public Health, here to protect you, your precious children, your lifestyle. And your salary.
Now, while everyone was still cringing after September 11, someone with considerable sophistication (and apparently, inside access to advanced bioweapons technology) sprinkled Anthrax spores through the U.S. Postal Service. So they (you know, “They”) shifted our focus from hijacked airplanes to something even scarier – laboratories. Labs hidden behind hermetically sealed doors. Labs dark at night, except for a single light illuminating the nefarious work of some twisted scientist. Labs teeming with bizarre microbes most people don’t understand which – like everything we don’t understand – automatically makes them scary.
People demanded that Congress act. Congress did act. Congressmen who wish to act, really have only two options: pass a law making such activity illegal (oops – too late – already done long ago), or throw money at the Problem.
So they backed up a fleet of dump trucks to our Nation’s treasury, and the Bio-Terrorism extravaganza was on.
Before we get to the Main Attraction, take a stroll with me past the carnival Sideshows:
“Federal funds have recently been released to your State!” the bold print blasted from one unsolicited letter. If they hadn’t been limited to paper and ink, the words would have been written in flashing neon, surrounded by an oval of glaring bare bulbs, accompanied by dinging bells and probably, a siren.
Another hawker tried name dropping: “The CDC, FEMA, and Homeland Security all say that no one should be without – – –”
O.K. Now that they have our attention, what are they selling?
– Biological Weapons detection devises that fit right into your pocket!
– A pre-fab steel plated “Safe House” for your family! (including the dog). This backyard bunker is featured in full, glossy, color, painted red, white and blue in a pattern you can guess. Picture that next to the swing set.
– Fever detecting thermometers shaped like credit cards which you can carry in your wallet or purse, wherever you go! Because everyone should know the instant they come down with Smallpox. “Free shipping on orders over 500.”
– Consultants! Specializing in writing your required Plans and grant applications. So now you can use the cascade of Federal dollars to hire someone to obtain the cascade of Federal dollars.
– Bomb scene investigation films! (Uh-h, isn’t that, like, too late?)
– Seminars on how to put on Hazardous Materials suit and respirator. To be held in Honolulu.
And dozens – believe me – dozens more.
But the Main Attraction, from this Blog’s perspective, is the wholesale sell-off of Public Health.
The time-proven approach to providing Community-Based Health Care (which is what Public Health does) is to first diagnose the Patient. Just as your physician would. In the case of Public Health, the “patient” is your Community. Is AIDS your biggest problem? Are Teen Pregnancies more common than elsewhere? Is your Community’s water contaminated? Are you confronting an outbreak of hepatitis?
Every Community’s disease profile is different (just as each individual patient in a private Doctor’s office is different). That’s why Public Health is best done at the local level, not by State or Federal governments.
So let’s say your Community has a higher rate of childhood brain cancer than similar communities. That’s the Diagnosis. If you were the Public Health Officer, having made the diagnosis, you’d next direct therapy to attack that problem. “Therapy” in Public Health is not pills and surgery, it’s money and people organized in a creative way to address the problem. People like nurses who can do epidemiological investigations of childhood cancer, and Environmental Health Scientists who sleuth out the culprits. Without either one of those tools, you can’t create a “Therapy” that fits your community’s specific Public Health problem.
But what’s evolved over recent years is a system where the Federal and State governments funnel money down to local Health Departments, specifically earmarked for certain programs. Like addicts, Health Departments almost never say “no” to this money, even if the program attached to the money is not needed in that Community. You can use the money to keep valuable employees on the job when their salaries are threatened. But those employees will need to change their program focus. So now you have nurses trained in Child Health suddenly working in Bio-Terrorism Preparedness or Environmental Health Scientists investigating cigarette smoking in public buildings. I am not kidding here.
And if a Local Health Department keeps this up for a while, soon it’s not out there “diagnosing” and “treating” the health ills of its Community; it’s running programs which were dictated to them from afar. Programs they have to “sell” to the Community, since the Community doesn’t really need them.
What can happen as a result? In the 1960’s and ‘70’s, we discovered a handful of effective antibiotics to cure Tuberculosis. As a result, the rates of TB started to drop. So, funding for TB began to dwindle. Less money for TB, more for sickle cell screening or for purchasing and installing specific computer programs. As the tool of money for TB withered, the tool of people skilled in TB investigation and management also shrank because their salaries dried up. Thus, by the 1980’s and ‘90’s, most Health Departments had few or no Public Health Nurses skilled in watching for and managing TB as a Community Health problem. They were all doing some other (well funded) program. Then, in the face of the double whammy of a new wave of immigration bringing more TB to the U.S., and AIDS epidemic devastating the exact part of the immune system used to control Tuberculosis, drug-resistant TB erupted, creating havoc in our communities. It took several years for us to re-build the infrastructure to control it. An infrastructure that Public Health once knew very well. An infrastructure that had been in place for over a century, but had been lost among the politically driven winds of diverted resources.
In the same way, Health Departments greedily gobbled up Bio-Terrorism money in the early 2000’s, and hired people to comb their Community for Anthrax, Smallpox and Tularemia. Or, more accurately, to write Plans about how to comb their communities for those rare and exotic diseases. Entrepreneurs made small fortunes selling Bio-Terrorism related trinkets.
And if childhood brain cancer was out of control in your Community, it was suddenly getting a lot less attention as Public Health focused on the sexy Bio-Terrorism thing.
Now, when you go to your Doctor with a pain in your wrist, do you want him to give you a few samples of the latest, greatest, newest drug on the market for pain (drugs left at the Doctor’s office by salesmen, hoping for profits as your Doctor prescribes it after the samples run out) or would you rather have your Doctor diagnose your wrist problem and treat you specifically for that?
That’s what Communities should do. Tell their Health Departments – who are the Community’s Doctor and who work for the Community – to stay focused on the local issues that are actually affecting people. And tell their congressional representatives to fund Public Health, rather than the categorical programs de jour which look sexy, like flashing neon.
Public Health should be your Community’s Doctor, not a circus.
Sex, Drugs, and Public Health 