Public health is a national asset

Disease prevention and health protection is the duty of all citizens and organizations. Disease is the outcome of the interaction between the environment, disease-causing agents, and humankind. The balance established to sustain health and prevent disease is dependent on space and time dynamics. Seasonal changes in weather cause escalation in disease transmission resulting in outbreaks.

 

Whereas every individual is endowed with the capacity to fight and even defeat disease, there are many socio-economic changes that are driving increased disease transmission. Population migration, aging, and environmental changes act in concert to amplify the disease burden.

Governments are the custodians of instruments and tools that can be used to control disease and preserve human health. Governments have two avenues to address their health roles. One is by directly offering health services to the citizens and secondly by creating an enabling environment for private institutions to offer quality healthcare. The role of the government as a health service provider is not in doubt, however, questions of quality arise time and again. As such there is a need for independent quality and standards assurance institutions to guide quality service provision in government institutions. In the private sector, the imperative of supervision and regular inspection must be most important. Quality health care is not expensive but effective and efficient. Many populations have been conditioned to view health quality in terms of cost rather than cost-effectiveness and cost-efficiency. Consequently, some professionals have taken advantage of the perception that expensive healthcare is quality with disastrous outcomes.

 

 Governments that are constantly at war lose the capacity to manage diseases. Studies have shown that countries that are at war are constantly faced with epidemics and health crises. Interestingly, some countries with established governments have displayed health statuses that bear similarities with failed states. A closer look at the value of public health as an asset, reveals that states that have a significant proportion of the GDP committed to health have commensurate returns in terms of economic growth. Disease burden at the family level impacts income by depleting available resources and limiting the time available for income generation. Within countries, studies have shown that counties, provinces, and districts that have poor health indicators are also likely to be economically low. Economic growth, if well-structured provides for healthy infrastructure development. On the flip side, unplanned economic growth is fraught with unhealthy outcomes. For instance, discoveries of oil and other minerals in some parts of the world have attracted uncontrolled cheap labor. Oftentimes, many laborers work under extreme health conditions without Medicare and judicial representation. Consequently, populations that work under such extreme conditions have increased disease burden and unfavorable economic-and health tradeoffs. For instance, studies have reported that populations living in the above-mentioned conditions spend up to 80% of their income on health. This situation is compounded by the adverse socio-economic environment that spurs crime and unhealthy lifestyle such as alcohol abuse and drug addiction. The interplay amongst the various variables produces poor health outcomes and very high mortality rates. Whereas, such scenarios have characteristic signature of slum settings, it bears similarities to the asbestos mines of South Africa and the mineral mines of DR Congo. Is it diseases that promote drug addiction or the converse? Either way, there is a feedback effect associated with disease burden and social determinants of health. The government is obligated by law to ensure that the socio-economic determinants of health are favorable for economic growth and development. As such governments ought to put in place systems that are competent to maintain healthy populations through infrastructure and policy development. Importantly, policy frameworks that cannot be implemented need reviewing in order to deliver the desired outcomes. Health policies that are not abreast with emerging and technological advances should be abandoned if they are rigid. Accordingly, training and capacity building is a keystone pillar toward strengthening a vibrant public health policy. Policies on health may have universal qualities, however, regional idiosyncrasies must be taken into account during implementation. For example, in many LMICs, there are challenges associated with physical infrastructure, policy implementation and lack of technical know-how as well as understaffing. As such, the alternative and traditional health care practitioners play a complementary role. Therefore, there is need for proper integration of traditional, complementary and alternative medicine (TCAM) into the healthcare system. Through taking such action, there will be a reduction in disease burden via several axes namely; improved help-seeking behavior, enhanced acceptability, compliance with health prescriptions and citizen to citizen health responsibility.

 

Recommended further reading

 Müller O, Krawinkel M. Malnutrition and health in developing countries [review]. CMAJ 2005;173(3):279-86. [PMC free article] [PubMed]

 Link BG, Phelan J. Social conditions as fundamental causes of disease. J Health Soc Behav. 1995;Spec No:80-94.

 Brooks-Gunn J, Duncan GJ. The effects of poverty on children. Future Child. 1997;7(2):55-71.

Berkman LF, Kawachi I. A historical framework for social epidemiology. In: Berkman LF, Kawachi I, eds. Social Epidemiology. New York, NY: Oxford University Press; 2014.

Phelan JC, Link BG, Tehranifar P. Social conditions as fundamental causes of health inequalities: theory, evidence, and policy implications. J Health Soc Behav. 2010;51 Suppl:S28-S40.

Macintyre S, Ellaway A, Cummins S. Place effects on health: how can we conceptualise, operationalise and measure them? Soc Sci Med. 2002;55(1):125-139.

Robert Wood Johnson Foundation. Mapping life expectancy. Short distances to large gaps in health. Accessed March 22, 2021. www.rwjf.org/en/library/articles-and-news/2015/09/city-maps.html

Schoen C, Radley D, Riley P, et al. Health care in the two Americas. Findings from the Scorecard on State Health System Performance for Low-Income Populations, 2013. Accessed March 22, 2021. www.commonwealthfund.org/sites/default/files/documents/___media_files_publications_fund_report_2013_sep_1700_schoen_low_income_scorecard_full_report_final_v4.pdf   

Booske BC, Athens JK, Kindig DA, Park H, Remington PL. County health rankings working paper. Different perspectives for assigning weights to determinants of health. University of Wisconsin Population Health Institute. Accessed March 22, 2021. www.countyhealthrankings.org/sites/default/files/differentPerspectivesForAssigningWeightsToDeterminantsOfHealth.pdf

County Health Rankings & Roadmaps. County Health Rankings model. Accessed March 22, 2021. www.countyhealthrankings.org/explore-health-rankings/measures-data-sources/county-health-rankings-model  

Phelan JC, Link BG, Tehranifar P. Social conditions as fundamental causes of health inequalities: theory, evidence, and policy implications. J Health Soc Behav. 2010;51 Suppl:S28-S40.

McIntyre L, Connor SK, Warren J. Child hunger in Canada: results of the 1994 National Longitudinal Survey of Children and Youth. CMAJ 2000:163(8):961-5. [PMC free article] [PubMed]

National Academies of Sciences, Engineering, and Medicine. Communities in action. Pathways to health equity. Accessed March 22, 2021. www.nap.edu/catalog/24624/communities-in-action-pathways-to-health-equity

Anderson LM, Scrimshaw SC, Fullilove MT, Fielding JE, Task Force on Community Preventive Services. The Community Guide’s model for linking the social environment to health. Am J Prev Med. 2003;24(3 Suppl):12-20.

Berkman LF, Kawachi I, eds. Social Epidemiology. New York, NY: Oxford University Press; 2000.

Riste L, Khan F, Cruickshank K. High prevalence of type 2 diabetes in all ethnic groups, including Europeans, in a British inner city: relative poverty, history, inactivity, or 21st century Europe? Diabetes Care. 2001;24(8):1377-1383.

Healthy People 2030. Social determinants of health. Accessed March 22, 2021. https://health.gov/healthypeople/objectives-and-data/social-determinants-health

Bureau of Justice Statistics. Household poverty and nonfatal violent victimization, 2008-2012. Accessed March 24, 2021. www.bjs.gov/index.cfm?ty=pbdetail&iid=5137

Chetty R, Stepner M, Abraham S, et al. The association between income and life expectancy in the United States, 2001–2014. JAMA. 2016;315(16):1750-1766.

National Center for Education Statistics. Trends in high school dropout and completion rates in the United States: 1972–2009. Accessed March 24, 2021.  https://nces.ed.gov/pubs2012/2012006.pdf  

Olshansky SJ, Antonucci T, Berkman L, et al. Differences in life expectancy due to race and educational differences are widening, and many may not catch up. Health Aff (Millwood). 2012;31(8):1803-1813.

Walker ER, Druss BG. Cumulative burden of comorbid mental disorders, substance use disorders, chronic medical conditions, and poverty on health among adults in the United States. Psychol Health Med. 2017;22(6):727-735.

Van Doorslaer E, Masseria C, Koolman X; the OECD Health Equity Research Group. Inequalities in access to medical care by income in developed countries. CMAJ 2006;174(2):177-83. [PMC free article] [PubMed]

Evans GW, Kim P. Childhood poverty and health: cumulative risk exposure and stress dysregulation. Psychol Sci. 2007;18(11):953-957.

Lipina SJ, Colombo JA. Poverty and Brain Development During Childhood: An Approach from Cognitive Psychology and Neuroscience. Human Brain Development Series. Washington, DC: American Psychological Association; 2009.

Farah MJ, Noble KG, Hurt H. Poverty, privilege, and brain development: empirical findings and ethical implications. In: Illes J, ed. Neuroethics: Defining the Issues in Theory, Practice, and Policy. New York: Oxford University Press; 2005.

Hoffmann JA, Farrell CA, Monuteaux MC, et al. Association of pediatric suicide with county-level poverty in the United States, 2007-2016. JAMA Pediatr. 2020;174(3):287-294.

Stringhini S, Sabia S, Shipley M, et al. Association of socioeconomic position with health behaviors and mortality. JAMA. 2010;303(12):1159-1166.

Glass TA, McAtee MJ. Behavioral science at the crossroads in public health: extending horizons, envisioning the future. Soc Sci Med. 2006;62(7):1650-1671.

American Academy of Family Physicians. Integration of primary care and public health (position paper). Accessed March 24, 2021. www.aafp.org/about/policies/all/integration-primary-care.html  

U.S. Department of Health and Human Services. National CLAS Standards. Accessed March 24, 2021. https://thinkculturalhealth.hhs.gov/clas

Houston TK, Allison JJ, Sussman M, et al. Culturally appropriate storytelling to improve blood pressure: a randomized trial. Ann Intern Med. 2011;154(2):77-84.

Brcic V, Eberdt C, Kaczorowski J. Development of a tool to identify poverty in a family practice setting: a pilot study. Int J Family Med. 2011;2011:812182.

Braveman P, Dekker M, Egerter S, Sadegh-Nobari T, Pollack C. Housing and health. Robert Wood Johnson Foundation. Accessed March 24, 2021. www.dhss.delaware.gov/dhss/dph/mh/files/housingandhealth.pdf

Zuckerman B. Promoting early literacy in pediatric practice: twenty years of Reach Out and Read. Pediatrics. 2009;124(6):1660-1665.

O’Campo P, Dunn JR, eds. Rethinking Social Epidemiology: Towards a Science of Change. New York, NY: Springer; 2012.

World Vision. What is poverty? It’s not as simple as you think. Accessed March 22, 2021. www.worldvision.ca/stories/child-sponsorship/what-is-poverty#:~:text=1.-,What%20is%20the%20definition%20of%20poverty%3F,care%2C%20education%20and%20even%20transportation

Office of the Assistant Secretary for Planning and Evaluation. 2020 poverty guidelines. Accessed March 22, 2021. https://aspe.hhs.gov/2020-poverty-guidelines

United States Census Bureau. Income, poverty and health insurance coverage in the United States: 2019. Accessed March 22, 2021. www.census.gov/newsroom/press-releases/2020/income-poverty.html

United States Department of Agriculture. SNAP special rules for the elderly or disabled. Accessed March 22, 2021. www.fns.usda.gov/snap/eligibility/elderly-disabled-special-rules

U.S. Centers for Medicare & Medicaid Services. Federal poverty level (FPL). Accessed March 22, 2021. www.healthcare.gov/glossary/federal-poverty-level-fpl/