Sex, Drugs, and Public Health

Among the on-going challenges of contaminated water, cases of communicable disease, and various Public Health emergencies, I’ve noticed a larger pattern. Almost every decade, some major Public Health problem grows into an epidemic that plagues us for years. So, what’s coming next?

                                                                                                                   (photo by Sarah Mosher)

In the early 1980’s after I’d returned from South America, a patient walked into a doctor’s office, terrified that he had melanoma. He was young – too young for a fatal disease, he told his doctor – just 27. But these spots on my skin – – –

The doctor, after examining him, was reassuring. Doesn’t look like melanoma. A biopsy will tell us.

It turned out to be Kaposi’s sarcoma. A disease I’d heard of – once – in Med School, but never seen. Not even in towering teaching hospitals in New York City or Los Angeles. My 2400 page textbook of Medicine mentioned it just once, in only eighteen words, within a table of multiple other obscure skin conditions. It was endemic to Africa, but exceedingly rare in the U.S.

Or had been, up until the 1980’s.

AIDS soon erupted into the number one Public Health epidemic in the U.S. and, quickly, in much of the rest of the world. Jet travel accelerated this disease’s spread, unlike the inevitable but slower spread of Tuberculosis or Syphilis – both major Public Health epidemics in prior centuries.

It’s not much in the news anymore. The non-journalistic reasons include discovery of some very good suppressant drugs and an impressively effective Public Health education effort.

So what is the most likely candidate as the next major epidemic which Public Health physicians and other professionals will be combatting for a decade or two?

Just as AIDS was the underlying condition which spawned outbreaks of Kaposi’s, of unusual lymphomas, and of uncontrolled invasion by microbes previously classified as “benign,” Climate Change will spawn multiple Public Health outbreaks.

Think of Climate Change as the growing epidemic of the 2016 – 2036 decades. What health problems will spring from it?

1. As the planet warms, mosquitoes, ticks and other insect vectors can expand their territories to the north (2015 was the hottest year, planet-wide, since we began keeping records 136 years ago. It quickly surpassed what is now the second-hottest year – 2014).

As the vectors move north, and travellers to tropical vacation spots return home during some virus’ infectious period, the potential for spread of seldom or never seen diseases increases at these latitudes.

For example, Lyme-infected ticks have been increasing in numbers and have been found further north in Canada. Species of the Aedes mosquito which can carry Yellow Fever, Dengue, Chikengunya and now, Zika viruses have been found in the southern U.S. Some species of Aedes have been found as far west as California and as far north as New York.

*Chikengunya, originally of Africa, spread to the Caribbean, right next door, in 2013. Within a year, it had hit the U.S.

*Dengue, originally of the Caribbean, showed up in Texas in 2004 and Florida in 2009.

*Zika virus, originally of Africa and Brazil, is already in northern Mexico. As of January 20, there have been a dozen imported cases of Zika in the U.S..

Are all these diseases certain to become established in the U.S.? Nothing is certain in Medicine. But now, because of Climate Change, it is very possible.

2. Other than these arthropod-borne diseases, other Climate Change triggered Public Health problems will be Emergencies caused by Extreme Weather events (earlier and more powerful hurricanes, floods, heat waves, fires, drought).

                                       (drought and beetle-killed trees in Mariposa, Calif)

3. Also, we anticipate more frequent and severe Air Pollution emergencies from increased smog, more pollen allergens, and smoke from fires.

What can you do?

1 Start acclimating and adapting. Stop hiding in the AC on a daily basis. Use the AC only when really necessary (the hottest summer days), and set it higher than 68 – like 80.

2 Install Solar panels and house batteries to run the house and you don’t have to worry about power outages.

3 Start conserving water. Catch rain water and reuse greywater.

4 Eliminate mosquito breeding areas around your home including old tires, birdbaths, pails and other containers and flower pots outside your home.

And for the Visionaries and Leaders among you, do what is necessary to get us all off fossil-fuels and on renewable sources as quickly as possible.

The Health of the Public (which includes you and your children) depends on us taking action.