How Healthy Is America’s Public Health Infrastructure?
By Jeff Turrentine
From day to day, our public health infrastructure — the people and systems we've put in place to keep populations, as opposed to individuals, healthy — largely goes unnoticed. That's because when it's working well, its success takes the form of utter normalcy.
Never mind that a vast number of people from a wide variety of fields — science, medicine, law, engineering, education, advocacy, and public policy — must work tirelessly (and often thanklessly) to grace our everyday lives with that blissful sense of normalcy. If you pour and drink a glass of tap water, head outside to take in some fresh air, then come home and prepare dinner, you can thank a public health worker for making every step of that routine healthier.
But there are times when we suddenly become very aware of just how well our public health systems are, or aren't, working. Today, in the midst of a pandemic, we're living through one of these moments. Our public health infrastructure is being tested. And as the COVID-19 crisis continues to intensify, it has become glaringly apparent in most parts of the country that this infrastructure is underfunded and overstressed.
A Washington Post article from two weeks ago, written before "social distancing" became part of our lingua franca, explored some of the reasons why. Because public health infrastructure targets the entire populace, the article observed, its mission "has been consistently overlooked in a country that puts a premium — and spends more money per capita than any other — on treating individual sick people. Its victories are soon taken for granted." The author cites figures from a 2019 paper published in the American Journal of Public Health showing that our country's investment in public health is currently $19 per person annually. According to experts in the field, that's $13 less than what it should be.
Meanwhile, we Americans spend, on average, almost $11,000 per person annually on treatments for the various diseases and conditions that routinely befall us. When people complain about the oppressive costs of health care, it's this back-end spending that they're talking about. But guess what? The country could lower these costs significantly by making smarter investments at the front end — i.e., spending more to protect the health of the public as a whole.
"There's a real need for people to see how the public health agenda directly protects everyone's well-being by addressing the root causes of disease and early death," said Vijay Limaye, an environmental health scientist at NRDC's Science Center. Investments in public health also help to make individuals more resilient. As an example, Limaye noted that "our country's progress on cleaning up air pollution has sharply reduced the burden of disease, including heart and lung conditions that put certain people at higher risk of severe illness from the coronavirus."
And right now, as local and state officials struggle to persuade some in their communities to heed the warnings against gathering in groups, another aspect of our public health infrastructure has risen in importance: communication. Few Americans knew what "flatten the curve" or "social distancing" meant three weeks ago. But thanks to creative, relentless messaging and the power of the internet and social media, Limaye said, "we're able to get the word out about the urgent need to slow down the rate of infections and better equip our health-care professionals on the front lines."
Though President Trump and some state officials have expressed impatience with social distancing measures that have closed businesses and caused unemployment to soar, there's little question that these are effective strategies for slowing transmission rates. Kinsa, a health technology company that makes digital thermometers and tabulates data on its customers' readings and reported symptoms, said the number of people exhibiting flulike symptoms such as fever began dropping precipitously and immediately after social distancing rules went into effect in places like New York City and Northern California. The same data set also reveals that incidences of flulike illness increased in cities and regions that were late in taking action, such as South Florida.
In the gap between those two trajectories, we see the difference between a robust, nimble public health response and an ill-prepared or hesitant one. And when you compare nations, the importance of early and accurate data collection — combined with powerful, consistent messaging — becomes even more apparent. South Korea was hit hard by the coronavirus in late February and early March, at one point reporting almost 1,000 new cases in a single 24-hour period. But thanks to a national strategy that has emphasized testing, social distancing, self-isolation, and GPS- and cell-phone-aided tracking and communication, this country of almost 52 million people reported only 64 new cases on Monday.
That's how public health infrastructure is supposed to work in the midst of a pandemic. "Other countries like South Korea are miles ahead of the United States on early and aggressive disease tracking and targeted health-risk communication, using things like location-based phone applications," Limaye said. "It's time that we harness 21st-century tools to better protect our citizens. In the year 2020, the public demands timely, transparent, and trusted information. There's simply no excuse for delays or deficiencies in reporting testing and health data."
But that, of course, would require a much greater investment than what America is currently making. In the 2019 paper on public health spending mentioned above, the authors recommended creating a $4.5 billion public health infrastructure fund that could generate new, permanent resources for state and local governments across the country. That probably sounded like a lot of money to any legislators who bothered to read the report when it came out. But now lawmakers are hashing out the final details of a $2 trillion relief package designed to save an economy that's been ravaged by the rapid spread of a dangerous communicable disease.
Let's hope it helps. And let's hope that all of us come to understand the importance of social distancing, hand washing, and other strategies for combating the spread of the coronavirus — strategies brought to you by the highly informed, highly dedicated public health professionals who are always looking out for us, 24/7, whether we're struggling through a pandemic or just going about our day.
Reposted with permission from onEarth.
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By Brian Bienkowski
Fish exposed to endocrine-disrupting compounds pass on health problems to future generations, including deformities, reduced survival, and reproductive problems, according to a new study.
Low Levels Lead to Generational Impacts<p>Researchers exposed inland silverside fish to bifenthrin, levonorgestrel, ethinylestradiol, and trenbolone to levels currently found in waterways.</p><p>"Our concentrations were actually on the low end" of what is found in the wild, DeCourten said, adding that it was low amounts of chemicals in parts per trillion.</p><p>Bifenthrin is a pesticide; levonorgestrel and ethinylestradiol are synthetic hormones used in birth controls; and trenbolone is a synthetic steroid often given to cattle to bulk them up.</p><p>Such endocrine-disruptors have already been linked to a variety of health problems in directly exposed fish including altered growth, reduced survival, lowered egg production, skewed sex ratios, and negative impacts to immune systems. But what remains less clear is how the exposure may impact future generations.</p><p>For their study, DeCourten and colleagues started the exposure when the fish were embryos and continued it for 21 days.</p><p>They then tracked effects on the exposed fish, and the next two generations.</p>
Inherited Problems<p>DeCourten said the altered DNA methylation is one of the plausible ways that future generations would experience health impacts from previous generations' exposure. Hormone-disrupting compounds have been shown to impact DNA methylation, which is an important marker of how an organism will develop.</p><p>"Methyl groups are added to specific sites on the genome, [the exposure] is not changing the genome itself, but rather how the genome is expressed," she said. "And that can be inherited throughout generations."</p><p>In addition, Brander said there are essentially different "tags" that exist on DNA molecules, which tell genes how to turn on and off. She said the exposure to different compounds may be "influencing which methyl tags get taken on or off as you proceed through generations."</p><p>The researchers said the study should prompt future toxics testing to consider impacts on future generations.</p><p>"The results … throw a wrench in the current approach to regulating chemicals, where it's often short-term testing looking at simple things like growth, survival, and maybe gene expression," Brander said.</p><p>"These findings are telling us we really at least need to consider" the next two generations, she added.</p>
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By Laura Beil
Consumers have long turned to vitamins and herbs to try to protect themselves from disease. This pandemic is no different — especially with headlines that scream "This supplement could save you from coronavirus."
Vitamin D<p><strong>What it is: </strong>Called "the sunshine vitamin" because the body makes it naturally in the presence of ultraviolet light, <a href="https://www.sciencenews.org/article/vitamin-d-supplements-lose-luster" target="_blank">Vitamin D is one of the most heavily studied</a> supplements (<em>SN: 1/27/19</em>). <a href="https://health.gov/our-work/food-nutrition/2015-2020-dietary-guidelines/guidelines/appendix-12/" target="_blank">Certain foods</a>, including fish and fortified milk products, are also high in the vitamin.</p><p><strong>Why it might help: </strong>Vitamin D is a hormone building block that helps strengthen the immune system.</p><p><strong>How it works for other infections:</strong> In 2017, the <em>British Medical Journal</em> published a meta-analysis that suggested a daily vitamin D supplement <a href="https://www.bmj.com/content/356/bmj.i6583" target="_blank">might help prevent respiratory infections</a>, particularly in people who are deficient in the vitamin.</p><p>But one key word here is <em>deficient. </em>That risk is highest during dark winters at high latitudes and among people with more color in their skin (melanin, a pigment that's higher in darker skin, inhibits the production of vitamin D).</p><p>"If you have enough vitamin D in your body, the evidence doesn't stack up to say that giving you more will make a real difference," says Susan Lanham-New, head of the Nutritional Sciences Department at the University of Surrey in England.</p><p>And taking too much can create new health problems, stressing certain internal organs and leading to a dangerously high calcium buildup in the blood. The recommended daily allowance for adults is 600 to 800 International Units per day, and the upper limit is considered to be 4,000 IUs per day.</p><p><strong>What we know about Vitamin D and COVID-19:</strong> Few studies have looked directly at whether vitamin D makes a difference in COVID.</p>
Zinc<p><strong>What it is: </strong>Zinc, a mineral found in cells all over the body, is found naturally in certain meats, beans and oysters.</p><p><strong>Why it might help: </strong>It plays several supportive roles in the immune system, which is why zinc lozenges are always hot sellers in cold and flu season. Zinc also helps with cell division and growth.</p><p><strong>How it works for other infections: </strong><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6457799/" target="_blank" rel="noopener noreferrer">Studies of using zinc for colds</a> — which are frequently caused by coronaviruses — suggest that using a supplement right after symptoms start might make them go away quicker. That said, a clinical trial from researchers in Finland and the United Kingdom, published in January in <em>BMJ Open</em> <a href="https://bmjopen.bmj.com/content/10/1/e031662" target="_blank" rel="noopener noreferrer">did not find any value for zinc lozenges</a> for the treatment of colds. Some researchers have theorized that inconsistencies in data for colds may be explained by varying amounts of zinc released in different lozenges.</p><p><strong>What we know about zinc and COVID-19:</strong> The mineral is promising enough that it was added to some early studies of hydroxychloroquine, a drug tested early in the pandemic. (Studies have since shown that <a href="https://www.sciencenews.org/article/covid-19-coronavirus-hydroxychloroquine-no-evidence-treatment" target="_blank">hydroxychloroquine can't prevent or treat COVID-19</a> (<em>SN: 8/2/20</em>).)</p>
Vitamin C<p><strong>What it is: </strong>Also called L-ascorbic acid, vitamin C has a long list of roles in the body. It's found naturally in fruits and vegetables, especially citrus, peppers and tomatoes.</p><p><strong>Why it might help:</strong> It's a potent antioxidant that's important for a healthy immune system and preventing inflammation.</p><p><strong>How it works for other infections: </strong>Thomas cautions that the data on vitamin C are often contradictory. One review from Chinese researchers, published in February in the <em>Journal of Medical Virolog</em>y, looked at <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/jmv.25707" target="_blank">what is already known about vitamin C</a> and other supplements that might have a role in COVID-19 treatment. Among other encouraging signs, human studies find a lower incidence of pneumonia among people taking vitamin C, "suggesting that vitamin C might prevent the susceptibility to lower respiratory tract infections under certain conditions."</p><p>But for preventing colds, a 2013 Cochrane review of 29 studies <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000980.pub4/full" target="_blank" rel="noopener noreferrer">didn't support the idea</a> that vitamin C supplements could help in the general population. However, the authors wrote, given that vitamin C is cheap and safe, "it may be worthwhile for common cold patients to test on an individual basis whether therapeutic vitamin C is beneficial."</p><p><strong>What we know about Vitamin C and COVID-19: </strong>About a dozen studies are under way or planned to examine whether vitamin C added to coronavirus treatment helps with symptoms or survival, including Thomas' study at the Cleveland Clinic.</p><p>In a review published online in July in <em>Nutrition</em>, researchers from KU Leuven in Belgium concluded that the <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000980.pub4/full" target="_blank" rel="noopener noreferrer">vitamin may help prevent infection</a> and tamp down the dangerous inflammatory reaction that can cause severe symptoms, based on what is known about how the nutrient works in the body.</p><p>Melissa Badowski, a pharmacist who specializes in viral infections at the University of Illinois at Chicago College of Pharmacy and colleague Sarah Michienzi published an extensive look at all supplements that might be useful in the coronavirus epidemic. There's <a href="https://www.drugsincontext.com/can-vitamins-and-or-supplements-provide-hope-against-coronavirus/" target="_blank" rel="noopener noreferrer">still not enough evidence to know whether they are helpful</a>, the pair concluded in July in <em>Drugs in Context</em>. "It's not really clear if it's going to benefit patients," Badowski says.</p><p>And while supplements are generally safe, she adds that nothing is risk free. The best way to avoid infection, she says, is still to follow the advice of epidemiologists and public health experts: "Wash your hands, wear a mask, stay six feet apart."</p>
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