The Dark Days of the Republic

CSPAN had some very good programs on about the Civil War in the last few days. Not a bad idea given how quickly everyone forgot what really went on during that conflict. Even the man who perfected the shade of orange that Cheetos wanted to achieve for decades, our President, didn’t seem to understand the difference between George Washington and Robert E. Lee. (Hint: One helped start a country and freed his slaves while the other fought to maintain slavery and split up a country.)

In one of those programs, someone mentioned that the days of the Civil War were “the dark days of the Republic.” Can you imagine? If you lived along the front lines, you went from being a farmer or working in a small town or city to seeing soldiers march through and even burn down your entire town or city. There were no assurances that either side was going to win, so it didn’t matter if you lived in the Union or the South, things were bad.

After the most recent presidential election, a lot of my friends and colleagues were sure that the darkest days were coming. Cuts to the budgets of scientific and public health agencies started to be bandied about by the current administration. They were not worried about their own financial futures or even their careers. You don’t get into public health to become wealthy. They were worried about the further damage to public health that these budget cuts would bring.

As it is, we’re in a very dark place when it comes to public health.

First, maternal mortality actually rose in the United States during a period when maternal mortality worldwide fell. From the New York Times:

“The United States has become an outlier among rich nations in maternal deaths, according to data released Wednesday by the Institute of Health Metrics and Evaluation, a research group funded by the Gates Foundation and based at the University of Washington.

There were 28 maternal deaths — defined as deaths due to complications from pregnancy or childbirth — per 100,000 births in the United States in 2013, up from 23 in 2005, the institute found. The rate in 2013, the most recent year for which the institute had detailed data for the United States, was more than triple Canada’s. The institute is projecting that the American rate dipped in the last two years to 25 by 2015.

Increases were extremely rare among rich countries. In all, 24 countries had one from 2000 to 2015, including South Sudan and the Democratic Republic of Congo, though their rates were much higher. America’s increase put it above a number of poorer countries whose rates had declined with the global trend, including Iran, Vietnam, Russia and Romania.

In all, the American rate was up by more than half since 1990, according to the institute, which uses many data sources, including countries’ vital records systems, to calculate hundreds of health measures.”

In the past, I’ve criticized comparing American fetal and maternal deaths to the rates of other countries because we do surveillance for these things different. I am still cautious about this. However, it’s the trends that are really worrying. Even with all the advances in medical technology, we continue to trend upward. Why? That’s a whole discussion for another post at a later time.

Next, alcohol consumption. From NPR:

“More Americans are drinking alcohol, and a growing number of them are drinking to a point that’s dangerous or harmful, according to a new study published in JAMA Psychiatry this week.

The study, sponsored by a federal agency for alcohol research, examined how drinking patterns changed between 2002 and 2013, based on in-person surveys of tens of thousands of U.S. adults.

They found that drinking, in general, rose substantially over that time frame. Problem drinking increased by an even greater percentage, and women, racial minorities, older adults and the poor saw particularly large spikes.

The findings suggest “a public health crisis,” the researchers say, given the fact that high-risk drinking is linked to a number of diseases and psychiatric problems, as well as violence, crime and crashes.”

Again, the problem here is the trend and the direction of the trend. With the large underfunding of mental health problems, and with alcohol addiction having an enormous mental health component, this is only going to get worse. And probably not just with alcohol but with other forms of “self-medication.”

And then, as we all know by now, we’re in the middle of an epidemic of opioid drug use and abuse. The Mayor of Nashville recently announced the death of his son from an overdose. The son of a golf celebrity also recently died from an overdose. Based on some of the preliminary mortality data coming out from colleagues at different health departments (state and local), the situation is bad. It is taking the lives, livelihoods, and futures of many young people in the United States.

It’s not just the attack on public health from the White House, either. The Governor of Maine keeps putting up roadblocks to access to narcan — an opiate antagonist drug given in an overdose in order to save the person from asphyxiation — despite all the evidence that narcan programs save lives and buy time for the person with an addiction to find help. The same kind of weird beliefs are shared by decision-makers at the local level, like a sheriff in Ohio.

So are these the dark days of the Republic? Maybe. Certainly, there have been dark days in this Republic for each generation. My father’s generation had the Cold War, the Kennedy Assassination, the Vietnam War, and the Nixon Administration. His father had World War II, the Korean War, and the Great Depression. In terms of public health, my grandfather grew up in times when epidemics of vaccine-preventable diseases killed off groups of children by the dozens in our ancestral town. Dad grew up during the big Rubella (German measles) outbreaks that left so many children with disabilities or death.

In a way, yes, these are our dark days.

It is then our responsibility to pull ourselves out of these dark days by working harder than ever. We inform policymakers of the science-based things they need to do to counter the trends described above. We work with local, state and federal agencies to make the most out of what we have. In essence, we take what little we will have, we make it work, and we make sure that the benefits of those things we do reach as many people as possible.

Yeah, we’ll have these dark days, and there will be more dark days ahead in future generations. But there’s also plenty of good people to be lanterns in the dark.

I'm a doctoral candidate in the Doctor of Public Health program at the Johns Hopkins University Bloomberg School of Public Health. All opinions posted here are my own, of course, and they do not necessarily reflect the opinions of my school, employers, friends, family, etc. Feel free to follow me on Twitter: @EpiRen