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The US is under several crises in public health, and we don’t have a Surgeon General why?

I have to thank Mr. Peter Breitner for pointing this out today to me on Facebook. Well, he and this blog post from this other guy. Anyway, what they pointed out is that in this fractured mess of an Ebola “crisis,” the United States finds itself without a Surgeon General. I’ll get into why it’s a big deal soon enough. Right now, I want to tell you about all the other public health crises we’re facing.

Ebola is scary, and it has killed thousands in West Africa because of different factors. The United States is not West Africa – for better or worse. We have a robust healthcare system with advanced technology and well-trained providers. Sure, access to care sucks big time, but even that is being worked out with the advent of the Affordable Care Act, aka Obamacare. (In fact, if I believed in conspiracies, I’d say that the ACA came along in anticipation of the Ebola scare.) For a disease like Ebola, where the person is not infectious until they’re symptomatic, and we know exactly how to contain it, what he have as far as healthcare will do.

What we have in terms of public health is about to be strained, though. But more on that in a second. (If you’re keeping tabs, I now owe you why not having a Surgeon General – only an acting one – is a big deal and why public health is about to be strained.)

The other public health crisis we’re about to face is influenza. I’ve told you before about how influenza is more of a threat to the United States than Ebola ever will, and why. The big why is the 3,000 to 49,000 deaths attributable to influenza that we’re about to see. That doesn’t count the thousands who will be out of work because they’re sick, or they’ll have to stay home from work to take care of sick dependents. It also doesn’t count the people who have preexisting medical conditions who will have those conditions worsened. Have you ever seen a person with chronic obstructive pulmonary disease and influenza? It’s not pretty. Their lung capacity is already threatened as it is.

Another public health crisis that we cannot deny is the obesity epidemic and the wave of new diabetes and heart disease cases coming with it. As a fat person myself, I can tell you that it is very, very easy to gain an unhealthy amount of weight. Likewise, it is very, very hard to get rid of it. Even with my recent trip to Korea and the 12 miles per day that I put in walking, I don’t think I shed a pound. Food is delicious. Working out hurts. Prosperity has taken away our ability to burn calories and given us empty calories in return. Millions will die early and unnecessary deaths from this. (I hope I can avoid that fate.)

Of course, every public health professional worth their salt will tell you that HIV/AIDS is still out there, and it is still a crisis. Too many people have it. Too many people will catch it. And too many will die from it. Even with the new antiretrovirals out there, there is strong evidence that HIV/AIDS brings with it other diseases and conditions. That, and people with HIV/AIDS – at a population level – have other comorbidities and lack of access to proper care.

So let’s get to what I owe you. First, not having a Surgeon General is a big deal because we have a large and well-trained US Public Health Service corps that is lacking a leader. Yes, there is an acting Surgeon General, and he is doing a heck of a job, but the lack of an appointed and confirmed SG is a shame for a nation such as ours. A lot of those PHS professionals serve at home and abroad to address public health problems. A whole bunch of them are right now in West Africa, and many will soon come along. And there are others who serve alongside military branches in order to keep the troops safe and healthy. Not having a person at the top is, again, an enormous shame. The people of the United States, and the world, deserve better.

Second, public health is about to be strained because each suspected or possible Ebola case that starts to pop up now in the United States will require an entire platoon of epidemiologists and public health nurses and other people. Public health labs will have to test a lot of samples collected from a lot of scared people who will think that they were exposed to Ebola. Then, in the winter, they’ll have to test a lot of samples from people with influenza to continue to feed the information stream in influenza surveillance, one of the few ways we can predict what the next influenza season (and the one after that) will have in store for us.

That’s just Ebola and influenza. With the continued rejection of vaccines, public health workers are going to have to chase a lot of cases of measles around to try and find those exposed to the virus. Each outbreak costs public health thousands of dollars in finding contacts, offering and giving them treatment, and in following-up to make sure that those contacts don’t start their own outbreaks. And that’s just measles. Other vaccine-preventable diseases are making a comeback. Ohio just got through a sizeable mumps outbreak. California and other states are seeing more and more cases of whooping cough.

With less and less funding for public health, and less incentives in terms of compensation for people to get into public health, it’s going to be tough. Not having a clear leader at the Surgeon General position is a clear symptom of the dysfunction and lack of prioritization that our political leaders have adopted in their positions toward public health.

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René F. Najera, DrPH

I'm a Doctor of Public Health, having studied at the Johns Hopkins University Bloomberg School of Public Health.
All opinions are my own and in no way represent anyone else or any of the organizations for which I work.
About History of Vaccines: I am the editor of the History of Vaccines site, a project of the College of Physicians of Philadelphia. Please read the About page on the site for more information.
About Epidemiological: I am the sole contributor to Epidemiological, my personal blog to discuss all sorts of issues. It also has an About page you should check out.

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