Friday, April 22, 2016

The Planet and Public Health

Today is Earth Day in America, which seems to have assumed all the significance of Arbor Day.  But on this particular Earth Day, some 175 nations of the Earth are meeting at the UN to formally sign the Paris agreement on confronting the Climate Crisis.

There is optimism that the goals named in the agreement can be reached sooner than promised.  But there's also been news since the Paris negotiations that make addressing the causes of the climate crisis even more urgent.

I've noted several of these, but the Washington Post has a summary (How Earth itself has dramatically upped the stakes for the Paris climate accord,) and John Sutter at CNN a list of what needs to be done (Stop Ruining the Future.)

But in addition to addressing the causes, the climate crisis demands that we prepare to address the effects.  In supporting its position advocating efforts to address the causes, the American College of Physicians listed some of the effects that doctors--and public health systems--are already starting to confront:

Respiratory illnesses, including asthma and COPD. Rising temperatures are causing an increase in ozone pollution, smoke from wildfires, and allergens produced by weeds, grasses and trees. Homes affected by heavy rains or flooding can become host to toxic mold and fungi.

Heat-related illnesses, such as heat exhaustion and heat stroke, which are particularly dangerous for children and the elderly.

Insect-borne illnesses, like Zika virus, dengue fever and chikungunya, which are ranging farther north as mosquitoes thrive in warmer climates.

Water-borne illnesses, such as cholera, which can spread if drought causes poor sanitation or if heavy flooding causes sewer systems to overflow.

Mental health disorders, including post-traumatic stress disorder and depression connected to natural disasters, as well as the anxiety and stress that accompanies days of hot weather."

All of these require a public health response, but after decades of budget cuts and the demonization of public agencies, is the United States public health system up to the challenge?  Shouldn't we be urgently asking that question?

A lack of consensus on public health, a dearth of attention to these climate crisis threats and a general lack of knowledge can add up to a dangerous inability to respond in a public health emergency, spreading panic and discord which rapidly makes a bad situation worse.

For all the potential causes of virtual anarchy on any level, there are really two that can create anarchy quickly: a food availability crisis (which is often a food price crisis) or a public health crisis--the spread of a disease or condition without efforts that are effective and generally believed to be the right ones.

We don't have to go back in history to see some of the problems.  Laurie Garrett's review of Pandemic, a book by Sonia Shaw in the New York Times Book Review last month reveals giant failures among the world's nations to address public health concerns.  She tells of the mistakes made in early efforts to confront Ebola, resulting in thousands of deaths, and particularly the ongoing cholera crisis in Haiti, where it remains because of failure to fix the water and sewage systems.

Shaw's book itself offers a more than cautionary tale about how politics, psychology and ego can be stubbornly fatal in addressing epidemics, in her description of cholera in Europe in the 19th century, when evidence that pathogens in the water caused the disease was dismissed several times because of the belief (supported by politics and ego) that cholera was caused by the smell of human waste, which led to even more contamination of water and even worse outbreaks of the disease.

Public health, like the climate crisis itself, involves many interacting factors that must all be addressed simultaneously.  (Mosquito nets are useless unless there is a system to get them to the people who need them, as is not the case in much of Africa, for example.)  Public health requires cooperation in common efforts, and trust in public institutions.  As we've seen recently here in California, it only takes a small group refusing vaccination and inoculation to spread diseases that otherwise might disappear.

In fact many perennially common diseases from polio to measles began to disappear from American family life in the 1950s through the 1970s, when public trust in public health was high, and funding for public health was unquestioned.  We may face our next set of public health crises with neither of those.  

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