Popular Science writes about the most dangerous misconceptions about public health. There are probably as many opinions on what constitutes public health as there are people. Is junk food and sugary beverages a public health concern? What about obesity? The former are amenable to individual action, but some public health concerns require collective action. One example is cholera, a communicable waterborne disease that causes serious diarrhea, often leading to death. Between 1830 to 1850 cholera outbreaks in New York City killed one out of every 20 residents.
Cholera can cause diarrhea so severe and dehydrating that it proves fatal within hours. An infected person might lose a quart of fluid and critical minerals from their body every 60 minutes, until the resulting electrolyte imbalance leads to shock, kidney failure, coma, and death. In the 19th century, back-to-back-to-back cholera pandemics wracked the globe. People became ill en masse, especially in cities, dying miserable deaths by the thousands.
Dysentery, another waterborne pathogen that causes deadly diarrhea, is caught from consuming contaminated water. Dysentery followed ancient armies wherever they went. History records only two English kings killed in battle (Harold Godwinson at the Battle of Hastings and Richard II at the Battle of Bosworth Field). Yet, least three, possibly four English kings died from dysentery while on military campaigns. Several others later died of injuries suffered while on military campaigns, including William the Conqueror and Richard the Lionhearted. During wars, diseases killed more soldiers than weapons up until near the end of the 19th Century.
Diseases like cholera, dysentery and typhus are virtually unheard of today due to gains in public health. The birth of epidemiology was due to scientific analysis of the locations of wells and latrines compared to deaths in the city of London in 1854. More from Scientific American:
Targeted infrastructure projects and policies explain why. Both cholera and typhus spread through water and food, which can be contaminated by feces particles from infected people and animals. By tackling the sanitation crisis that contributed to the disease, New York dramatically cut case numbers.
Public health encompasses more than sanitation. Any action undertaken to reduce the risk of injury or death falls under public health, sometimes actions Americans object to. Take covid for example, encouraging mask wearing, social distancing and closing schools and businesses where people congregate was done to reduce the spread. Vaccination was also encouraged to create so-called herd immunity. Not everyone was happy, however.
Public health encompasses any and all actions at the societal and governmental level to ensure community health and safety. It is focused on preventing sickness and harm before it happens. Everything from seat belts, driver’s licenses, laws against drunk driving, vehicle design, and urban planning to municipal water testing and treatment, hand washing, flush toilets, and food recalls fall under public health’s vast umbrella, says Georges Benjamin, a physician, career public health official, and executive director of the American Public Health Association.
According to the U.S. Centers for Disease Control & Prevention (CDC), the Top 10 greatest public health achievements of the 20th Century are:
- Vaccination
- Motor-vehicle safety
- Safer workplaces
- Control of infectious diseases
- Decline in deaths from coronary heart disease and stroke
- Safer and healthier foods
- Healthier mothers and babies
- Family planning
- Fluoridation of drinking water
- Recognition of tobacco use as a health hazard
As you can see, not all of these are related to disease. A problem with public health is that much of the work done is invisible. When things go well nobody notices. When things go wrong, they often go viral (sometimes literally, other times figuratively). Public health officials often make mistakes.
If a public health agency changes a guidance, it can be easy to assume ineptitude–but it would be more accurate to assume that updated advice means updated information. It almost certainly means someone has worked to understand the problem better.
Throughout most of human history between one-third to one-half of babies died before their 5th birthday from childhood diseases. Vaccinations, food safety, sanitation and numerous other factors have all but done away with infant mortality. Childhood vaccinations prevent 14 childhood disease that often killed scores of babies in years past.
Which actions fall under public health can be controversial. For instance, should guns be considered a public health threat or a crime problem? Should sugary beverages and prepackaged foods be considered public health or a nutrition issue? Is workplace safety about public health or a labor issue? There will be tension whenever public health advocates attempt to expand the scope of their field into areas that reduce freedom or inhibit Americans’ prerogatives.
Read more at Popular Science: The most dangerous misconceptions about public health