“Public health” is a phrase that can be heard seemingly nonstop whenever there is a health scare or disease outbreak. The current measles outbreak is an example of this -- a public health issue that makes headlines for days, weeks or months at a time.
This week on “Take Care,” Dr. Leana Wen discusses that public health is actually an everyday affair -- one that needs to receive more attention -- to better prevent and resolve such outbreaks. Wen is a Harvard-educated emergency physician, the Baltimore City health commissioner and co-author of the book “When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests.”
Wen explains that a big contributor to one’s health isn’t even so much one’s genetic code, but their zip code.
“Healthcare isn’t just about where you get health, but actually where you live, where you go to school, who are the people that you’re next to; and that’s the importance of what we focus on, not just on sick care, but focusing on prevention, not just on diseases that occur but how to prevent them from happening,” Wen says.
Wen referenced several neighborhoods in Baltimore and Washington, D.C. where the average life expectancy can have a 20-year variance from neighborhood to neighborhood. She says issues like these not only affect the people that live there now, but the children growing up there, their individual futures and the rest of society.
“We need to make sure we raise the bar of health for everyone,” Wen says. “If we don’t have children who are achieving their full potential, then we are also not getting the best workforce that we can and that’s hurting everyone in our communities.”
Wen says the main obstacle in addressing certain problems regarding public health care is assuring that organizations have the ability or authority to take action. She believes the best way to organize the effectiveness of public health is to reach out to members of individual communities.
“One of the key things that I’m doing to start my term here at the Baltimore City Health Department is to meet with not only our city leaders and Mayor [Stephanie] Rawlings-Blake and our other fantastic officials, but also to engage with the community,” Wen says. “It requires genuine engagement with a community not only to say ‘here are the problems’ but rather ‘what do you think are the issues?’ ‘How can we best work together on these solutions?’ and ‘how can we tackle these serious injustices together?’”
One of the more recent threats to public health safety has been the outbreak of measles in several parts of the country. This, Wen explains, is an example of the funding cuts in several areas of public health which would help prevent these outbreaks, as well as the result of the new battle between mandated vaccines and those who choose to opt out of receiving them.
“It used to be thousands of people died from what we know now to be vaccinated-preventable diseases,” Wen says. “Right here in Baltimore back in the 1930s, there was a measles outbreak that killed hundreds of people that sickened, injured and permanently disabled thousands of our children and fear and tragedy spread throughout our city because people didn’t know when their children were going to fall ill and die and often suffer permanent brain damage and lung damage. We are fortunate that since the 1960s, we’ve had a vaccine for measles and vaccines for many other diseases that have cut out the deaths from many different diseases," Wen says. "And yet, it’s really sad that measles has come roaring back and that there are now hundreds of cases across the U.S. for something that was considered to be eliminated just a decade ago.”
One suggestion for this sort of scenario is what doctors have been calling “herd communities” or “community immunity,” which would require 95 percent of a community to be immunized for certain diseases, the exception being those with weaker immune systems like children under a year old or people undergoing chemo therapy. These sorts of things, Wen says, might provide a way to protect individuals and society altogether.
“In addition to safeguarding our own health and our families, we also have a duty to everyone else around us and it’s that obligation that we in Baltimore, but also our counter parts and public health officials across the country are working to safeguard every day,” Wen says.
