Domestic Threats to Public Health in the United States

True story.

If you’ve been watching the news, you might have noticed that something interesting is going in Italy. They just had a general election, and their results were very interesting. This is from The Atlantic:

“Anyone who’s spent more than a vacation in Italy knows it’s a country with deep reserves of discontent, economic stagnation, and political dysfunction. So the anti-establishment Five-Star Movement, which promises universal basic income and says it wants to clean up politics, and the right-wing League party, which made immigration and economic anxiety central issues, had plenty of anger to tap into ahead of Sunday’s national elections. And then they became the biggest winners, with more than half of the electorate between them.

The people have spoken. But what are they saying? There are two main ways to read the results, and both have major consequences for Europe. One—and this is entirely new—is that one of the three pillar countries of the European Union now effectively has a euroskeptical majority in parliament; both Five Star and the League have called for rewriting treaties with Europe to give Italy more sovereignty. (Although it’s a big question whether they would team up to form a government; the election results have produced a hung parliament.) The second is that voters are punishing Italy’s governing elites—Renzi’s Democratic Party, but also Silvio Berlusconi’s Forza Italia party—for overseeing the country’s decline.”

But there is also a public health component to the outcome of this election. From Time Magazine:

“Just over two years later that debate has gone from an online feud to a live political issue in the Italian general election due on March 4. As skepticism about vaccines has become widespread in Italy, so-called “anti-vaxxers” have become a voting bloc for the populist parties vying for votes. As a result, two of the leading populist parties — the far-right League (formerly the Northern League) and the anti-establishment Five Star Movement (5SM) — have pledged, if elected, to scrap a law passed in July that made ten vaccinations compulsory for children under the age of 16. If they do, health experts warn it could be a huge step backwards in the global fight for children’s health.”

And why would that be a bad thing? From The New York Times:

“Measles cases soared in Europe last year, and at least 35 children died of the highly infectious disease, according to the World Health Organization. The virus found its way into pockets of unvaccinated children all over the continent, from Romania to Britain. The number of recorded cases quadrupled, to 21,315 in 2017 from 5,273 in 2016, a record low.

The biggest outbreak last year was in Romania, where there were 5,562 cases and which accounted for most of the deaths. The country’s large rural Roma population — also known as Gypsies — often do not vaccinate their children and may not take them to hospitals promptly when they fall ill. The country also has an underfunded public health system.

The second biggest outbreak was in Italy, with 5,006 cases and three deaths; 88 percent of those cases were in people never vaccinated, and another 7 percent in people who had not had all the recommended doses, the European Center for Prevention and Disease Control said.”

So, seeing what happened in Italy, can we look at the United States and see where similar threats of public health are allying themselves with political discontent? I’m looking at you, Texas… From The Daily Beast:

“And then there’s the anti-vaxxer stuff. LaHood, whose son has autism, has appeared at anti-vaxxer conferences, using his district attorney title as proof of credibility. And in a promotional video for the anti-vaxxer movie Vaxxed, LaHood says: “I’m Nico LaHood. I’m the criminal district attorney in San Antonio, Texas. I’m here to tell you that vaccines can and do cause autism.”

Asked about his views at the Feb. 8 debate, LaHood said they were based on “a personal belief” based on “what my wife and I go through medically.” After his son developed autism, “we have an opinion of how that happened.”

In reality, there is absolutely no evidence that vaccines cause autism, and all major medical associations and the Centers for Disease Control and Prevention have affirmed the safety and necessity of vaccines. The one study that spawned the anti-vaxxer conspiracy has been debunked and retracted. Since it was published, 17 studies performed in seven countries on three continents involving hundreds of thousands of children have found that its hypothesis had been wrong. Meanwhile, parents refusing to vaccinate their children have led to outbreaks of measles across the U.S.

Now, as a district attorney, LaHood’s views on vaccines don’t come into play very often. Then again, some would say that science is not a matter of “personal belief,” and that subscribing to an anti-scientific conspiracy theory, even as a result of personal trauma, is relevant to how a prosecutor evaluates evidence.”

Mr. LaHood would eventually lose the primary, but he’s not the only candidate with anti-vaccine views.

It’s not just anti-vaccine politicians that are a threat to public health. (Or, rather, the policies they would pursue would be a threat.) You also have the candidates who oppose laws favoring safer guns, helmets while riding motorcycles or bicycles, pollution regulations to stave off global climate change, etc. There are very smart and/or very charismatic people vying for political office right now who are not afraid to throw out the science and evidence and go with their gut or with popular sentiment.

I worry also about the demonization of immigrants coming to the United States. There are, of course, hundreds of “news” stories about immigrants bringing diseases into the purity of our country. Never mind that measles cases are being brought in by US residents who travel abroad and are not vaccinated, for the most part. Never mind that children from “third world” countries are well-vaccinated, or that refugees escaping war are well-screened for infectious diseases as part of the process of coming into the United States.

Unfortunately, it’s not just the anti-immigration people in this country who are focused on public health threats from abroad. Back in 2009, everyone expected the next influenza pandemic to come from Asia in the form of avian (bird) influenza. A scientist at CDC told us at a conference that she expected the next pandemic to be swine flu from North America. Guess what? It was swine flu from Mexico, and the first cases were found in Texas and California.

When the Ebola epidemic was going on in West Africa, how many news reports pushed the possibility of cases landing in the United States and killing us all? How many politicians overreacted to those speculations and ordered American citizens into quarantine upon their return from helping save lives in West Africa? Meanwhile, that winter, between 3,000 and 49,000 people would die from influenza in the United States.

I mean, if you just look at the tables for the top causes of death in the United States, threats from abroad are not really anywhere near those lists. We are dealing with hundreds of thousands of deaths a year from heart disease, cancer, stroke, diabetes, Alzheimer’s, and suicide. Terrorist attacks? Yeah, there’s been a few, but none of them have come close to killing as many people as sedentary lifestyles and high-fat diets have.

Can you imagine if screeners at the airports stopped overweight and obese people and called them a threat to our public health? Or if cops came after you for smoking? And what if we forced the elderly to do puzzles all day and get plenty of exercise to stop Alzheimer’s? Or we forcibly medicated anyone and everyone who suffered from suicidal ideations? How many excess deaths would we prevent?

I know. I ask too many questions. But did you notice what all of those things have in common? They’re all things that we as individuals do to ourselves. Or, rather, there is the perspective that we do it to ourselves. No one is forcing us to sit for hours and eat unhealthy meals, but we can’t help it sometimes (or many times). Maybe Big Sugar and Big Fast Food haven’t gotten around to sending us political communiques as they threaten us with fatness, so we don’t consider them as enemies.

I’ve noticed this tendency to look out at the world with fear at the school of public health as well. There is a series of events coming up for “Public Health Practice” week, and a lot of the discussions and presentations are about what is going on outside the United States, particularly in areas with armed conflicts. The closest thing I’ve seen to a domestic issue is hurricane relief for Puerto Rico, and, even then, some students are not aware that Puerto Rico is a US Territory.

My sincere hope is not that we turn public health in the United States into some nationalistic version of what it is now. “America First” is just as hazardous to our health as focusing only on threats from beyond our borders. But there is something to be said about panicking over a physician or nurse coming back from helping out in West Africa and getting the sniffles instead of panicking over thousands of people who will needlessly die each winter because we can’t come up with a better influenza vaccine and/or because not enough people get the flu vaccine when they need to.

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