Public Health Concerns

[relentless11]

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Dear all doctors, and doctors to be:

I'm just wondering if you guys have some time to brainstorm a bit with me. I normally hang around in the pre-allopathic forums, but my research has required me to come down here to ask around for some knowledge.

I'm currently involved in writing a book (specifically 2 chapters) on Public Health. Specifically public health through out the world. As you may already know, many parts of the world do not have adequate healthcare. My questions to you guys here, based on your combined experiences in medicine, what do you think are the prime challenges faced by public health today in these areas (rural, slums, developing nations, etc).

My current list is as follows:

1) Sanitation
2) Lack of Medical Supplies/Technology
3) Access to Health Care (limited roads, transportation)
4) Overpopulation

Any thoughts? I want to thank you ahead of time for the assistance, and thoughts on this matter. Thanks!

 

[nuclearrabbit77]

i would include nutrition.

 

[Catalyst]

Originally posted by relentless11
Dear all doctors, and doctors to be:

I'm just wondering if you guys have some time to brainstorm a bit with me. I normally hang around in the pre-allopathic forums, but my research has required me to come down here to ask around for some knowledge.

I'm currently involved in writing a book (specifically 2 chapters) on Public Health. Specifically public health through out the world. As you may already know, many parts of the world do not have adequate healthcare. My questions to you guys here, based on your combined experiences in medicine, what do you think are the prime challenges faced by public health today in these areas (rural, slums, developing nations, etc).

My current list is as follows:

1) Sanitation
2) Lack of Medical Supplies/Technology
3) Access to Health Care (limited roads, transportation)
4) Overpopulation

Any thoughts? I want to thank you ahead of time for the assistance, and thoughts on this matter. Thanks!

I would second the comment about including malnutrition; in fact, I'm surprised it wasn't included in your current list! Check out www.unicef.org/nutrition for some statistics

 

[Kalel]

Personally, I think that the biggest public health crisis in our generation is in infectious diseases or preventing infectious diseases. HIV is an obvious one that has reached crisis proportions in many regions in Africa, with some villages being close to 100% HIV positive. I don't think that HIV drugs are the answer to this problem, since the drugs require full compliance with mult-drug regimens and extensive monitoring for them to be effective in adults, so I think that the biggest challenge we have with HIV is preventing infection in the first place. Condom distribution and education have been shown to work, but unfortunately, many religious organizations oppose these programs on "moral" grounds. A vaccine would be great, but most ID docs who I have talked with believe that an HIV vaccine is not likely in the forseeable future. Anyways, preventing future pandemics of new infectious agents (like SARS, new strains of influenza, super-resistant bacteria, etc) is definitely a under-addressed major international public health issue. These agents can be devastating in terms of morbidity and mortality, and one epidemic can have really extensive effects on local and international economies. People travel and don't obey quaritines, so it seems to me that it's only a matter of time before some disaster happens with these new infectious diseases we are seeing. Sadly, we also still have many very treatable infectious diseases like cholera or preventable diseases like polio that are still killing people in third world countries. I guess that ties in with your sanitation part though.

 

[relentless11]

Great! Thanks for the help.

Yes Infectious diseases are a big problem. We're looking into the big ones, malaria, HIV/AIDS, parasitic infections, etc. (and as mentioned, more recently SARS, avian flu) Obviously all of these are interrelated......hmmm ...maybe i should make a nice illustration for a figure...

Anyway, i wonder how prevelant drug resistant organisms are in these countries. From one perspective it could be less since less medical care is available, but on the other hand it could be more since medical aid might be more prone to using broadspectum antimicrobials. (and also considering that people might not stick with the therapy...if it happens here then it can happy anywhere)
I'm sure these will be available through literature searches.

Nutrition is also a good point...I will definately get something on that too.

Well definately thank you so much for the help. Feel free to provide any more input or discussion if you see fit. THanks again!

 

[LukeWhite]

I'm not so sure I'd add overpopulation...the last few hundred years has seen a trend of prosperity leading to lower birth rates, not the other way around. I'm not sure there's any example of a nation that's gotten more prosperous by having fewer children.

I would say that overpopulation poses a health problem insofar it triggers inhumane responses. China's policy of forced abortions and India's fast-growing tradition of doing ultrasounds to determine the sex of the baby and then aborting females are both direct responses to overpopulation. THAT'S a health crisis.

 

[relentless11]

Originally posted by lukealfredwhite
I'm not so sure I'd add overpopulation...the last few hundred years has seen a trend of prosperity leading to lower birth rates, not the other way around. I'm not sure there's any example of a nation that's gotten more prosperous by having fewer children.

I would say that overpopulation poses a health problem insofar it triggers inhumane responses. China's policy of forced abortions and India's fast-growing tradition of doing ultrasounds to determine the sex of the baby and then aborting females are both direct responses to overpopulation. THAT'S a health crisis.

The reasoning for this one here would ideally by India. Supposedly about 75% of all the health infrastructure in India are focused in areas where 27% of the population live. Overcrowding 1) increases unsanitary conditions in developing countries, 2) forces the population to spread out into underdeveloped areas, and so on.

I agree with your reasoning for inhuman responses though. That is definately a socialogical issue which should be addressed as well.

 

[Naphtali]

A few points, most of them inspired by other posts on this thread.

1. Sanitation is #1 on your list. This is correct. So many other diseases are caused by poor sanitation... lots of people die from diarrhea, intestinal parasites... diseases that aren't sexy, that don't kill people in the West, and so First Worlders don't think of them. Plus, things like lack of drainage of standing water cause mosquito borne diseases like malaria.

2. On that note, will you talk about the SHAMEFUL actions of the US and other nations regarding the pesticide DDT? The US gov't bans the sale of DDT to foreign countries. All this started because activists pushed for its ban because of (marginal) effects on wildlife. It does my heart good to see all the birds of prey; so what if millions of Africans had to die?

3. AIDS drugs are not a waste of money. But neither are they an effective strategy to stop the disease. Condoms are well and good, but also aren't really the answer. AIDS can be prevented almost for free: STOP SLEEPING AROUND, PEOPLE. Promiscuity is causing a terrible toll, particularly in Africa. The only way to beat AIDS is from within... local leaders need to encourage cultural change. Is it moral to spend so much on AIDS, and almost nothing on epidemics like malaria? (See also point 2 above... I'm coming to the unfortunate conclusion that many Western leaders don't really care about what's best for Africa.)

4. Nutrition is important, but keep in mind that in almost all areas, the situation has been getting better over the last several decades. Doomsday prophets like Stanford prof Paul Erlich have kept predicting mass starvation, and have kept being wrong. Maybe you could mention in your book Norman Borlaug. He's probably saved more lives than any other American; it's a shame so few know who he is.

5. Lastly, maybe you should mention the effect of pollution of the Third World. Most Westerners have no concept of what real pollution is. You think the smog is bad in LA? Go stand outside in Beijing... your white shirt will soon be gray from the soot. It's worst in the winter; then, the air is literally crunchy. And the water... I'd gargle with water from New York's East River before I'd even dip a finger in the Yellow River in China. Is it a suprise lung cancer is so common in China?

Naphtali