I believe in public health.

Because of people like John Snow, I believe that disease does not occur randomly.

Because of Edward Jenner, I believe that disease can be prevented, that we may act now to influence the incidence of future disease.

And because of Edwin Chadwick, I believe that people should be protected from dangerous social and sanitary conditions before these hazardous exposures cause disease.

I believe…that social and environmental determinants of health influence modifiable risk factors for disease.

I believe that public health’s role is to engage multiple sectors and community partners to generate a collective impact and improve these determinants of health and risk factors for disease.

I believe…in the ten essential public health services and in it’s purpose that includes prevention, protection, promotion, response, and equity of access and quality.

And I believe… that the highest degree of public health impact results from dealing with health determinants and risk factors compared to less effective clinical interventions, counseling, and education.

Why do I believe these things? I do so because they are proven.

And yet, to this day, public health has still not applied even these most basic principles and practices to address morbidity and mortality caused by disaster-related hazards.

  • The current reactionary approach is expensive, with unproven effectiveness.
  • There are no validated models for predicting disaster-related health risks.
  • Most disaster-related investigations assess victim don’t even assess the geographical location of the victim or the degree of hazardous exposure!

Considered in John Snow’s terms, every year (for decades now), we count the number of cholera cases without bothering to find the contaminated well – let alone remove the pump handle.

More recently, after Hurricane Maria hit Puerto Rico, US public health no longer counts the cases!

Over the past 50 years, the focus of the U.S. approach to managing environmental health emergencies (as compared to infectious disease emergencies) has been mostly reactionary and curative, rather than precautionary and preventive.

For this reason, we have very few measures of effectiveness for either public health preparedness or response after literally hundreds of millions of dollars in public and private investment. For this reason, we should return to the basics to address this health problem.

And it is also for this reason that I propose a new paradigm that is better aligned with public health principles and as a more equitable and effective application of public health practice as applied to disasters.

Society medicalizes social needs and uses disaster medical care to poorly compensate for a lack of social services

Until now, nearly all disaster-related disease management focused on (individual or societal) disaster-related health issues once they reach a point of crisis. At this advanced stage, health inequity is characteristically pervasive among most disaster-affected populations worldwide. Regardless of the hazard, the most likely victims are quite predictable. Those most likely to die in a disaster are the under-served and underprivileged of society. This population (which the system has labeled as “vulnerable” includes ethnic, religious, racial and political minorities, the poor, women, elderly, children, the socially isolated, and people living with chronic illness and disabilities.

These are not the signs of coincidence, but rather a systemic cause of variation – a systemic bias that has contributed to poor health outcomes for decades.

To be effective, public health interventions must also include measures that address social justice and health equity.

Health equity is best addressed by addressing upstream health determinants, not downstream public health crises.

Public health interventions must also include preventive, protective, and promotional measures that seek to modify the “upstream” factors, involving health determinants and associated risk factors, in addition to providing shelter and clinical care for the adverse health consequences that occur “downstream”, as a direct result of those influences.

Public health strives not only to reduce the prevalence of disaster-related injuries and disease but also to reduce the incidence. And the reduction of disease incidence requires prevention.

Contrary to its archaic approach to disasters, public health has traditionally focused on prevention as a primary strategy. U.S. public health was also founded within the very principles of utilitarian social justice and health equity philosophies that remain largely unaddressed by modern clinical emergency and disaster medicine.

This approach is grounded in science and dedicated to a code of ethics for public health that includes: 1) addressing the fundamental causes of disease and requirements for health; 2) respecting the rights of disenfranchised communities; 3) ensuring that the conditions necessary for health are accessible to all.

It also recognizes a socio-ecological model of health and that disasters are inherently political and local issues that often require a broader role in all public policies.

Or…is THAT the real reason why America chooses to ignore it?

Please leave your comments below and check out other DisasterDoc Blogs like: “The Duty to Protect” 



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