I am that “old-time” doctor. I now say, “Do you remember when? I do.”
I started medical school in 1992. Adding those years with residency and decades of clinical practice, I am at 32 years of experience and counting.
I remember watching a young boy in the halls of the pediatric hospital carrying his bucket to vomit as he coughed hard due to a pertussis infection. He couldn’t eat and maintain weight requiring a feeding tube. I remember having “the” talk with parents whose son went to bed sick with fever and headache who never woke up. Their son had meningitis and never recovered. There was also a seven-month pregnant mother sedated on a ventilator with pneumonia from the chicken pox virus she had caught from her toddler before the vaccine was available. Yes, those were days that many may not recall. A time that I would hope many would not want to go back to. The difference between then and now is the impact of public health.
Public health is the use of science to improve and protect the health of people within a community. This covers a wide range of practices including identifying and responding to infectious disease, promotion of wellness lifestyle, and prevention of injury and disease. Research and data are used to identify the best practices for the individual and their community.
Vaccines are on the forefront of reducing illness, injury and death. One of the first vaccines was the polio vaccine in the 1950s. The polio virus was extremely infectious and transmitted by person-to-person contact. This virus could invade the nervous system, causing various degrees of paralyzing muscles within the body. The most severe form required life support to breathe on an “iron lung.” A mild case could make a full recovery in a few weeks, but many developed lifelong weakness and even the inability to walk, the post-polio syndrome. Before the vaccine there were up to 58,000 annual cases, according to the World Health Organization.
I cared for a handful of these afflicted adults. When asked, they said they would have opted to receive the vaccine. The low risk of vaccine side effects and the extremely rare risk of a life-threatening reaction, versus the debilitating effects of the infection, would have been worth the risk.
Most don’t have to think about the impact public health policy makes upon our lives. Practices embedded within our daily lives prevent or intervene in the presence of significant disease. Simple rules of storage and temperature control of food at your favorite restaurant prevent food-borne illness. Handwashing, isolation procedures in the hospital, and mandated flu vaccines for health care workers has allowed many of our loved ones to avoid complications while being treated.
Vaccine mandates in schools saves days lost from school by students and days lost from work by their parents, greatly impacting our communities and local economy. That is not to mention the astounding number of children’s lives saved by vaccine mandates. Many common infections that caused long-lasting effects decades ago are rarely seen today. Much has been achieved through science and research that we take for granted every day.
Major changes made within this public health system will require understanding of the serious “jenga” effect which will occur. To remove or “soften” a policy will affect us all, much like removing that center wooden jenga piece within a tower. The whole system could fall upon itself. Our nation is already suffering from nationwide low staffing within our health care system since the pandemic. Primary care, mental health and dental health workforces are all facing the most significant shortages (State of the U.S. Health Care Workforce 2023, National Center for Health Workforce Analysis).
A choice made to soften or remove vaccine mandates in schools will result in the need make up for the lost days for those families that choose not to vaccinate. Already, many of them send their children to school sick rather than losing their job due to unavailable sick days. This in turn adds to more communicable disease. Will these sick patients get medical care as the need arises for primary care providers, clinics and hospital staff? Considering current shortages, can we meet this demand?
Most agree there needs to be adaptation and improvement to allow us to become a healthier nation. There are simple quick wins to do so. Improving access to healthy foods within reasonable cost, insurance coverage for registered dieticians and improving school breakfast/lunches – where our kids get almost 40% of their daily calories – can bring about significant results. Yes, decreasing ultra-processed food will reduce the risk of chronic disease over time. However, obesity is a complicated disease with many contributing factors. There is a need for an intervention for this epidemic now. Allowing access to needed resources and education to relieve the burden of obesity and its associated conditions would be a powerfully effective antidote that is urgently needed.
The most integral aspect of public health and its relation to our nation’s health is the need for us to practice it together. It’s not just about the “me” but it’s also about the “we.” This means a person who is low risk for a complicated illness from the flu decides to get the flu vaccine to protect the one at risk whom they may not know. This requires understanding that there are those struggling with their health who may need more resources than those who are not. Knowing and caring that what I may or may not do directly affects those around me is key. The foundation of science within public health is clear on this concept. There is no need to destroy or mistrust the structure on which we have relied, and which has allowed many of us to survive. To proceed in the destruction of this core value may cost all of us more than just time or money. It may cost many their lives.
Nicole Florence of Springfield graduated from SIU School of Medicine and completed a Combined Internal Medicine/Pediatrics Residency there. She practiced as a primary care physician at Memorial Health System for 20 years and is presently also Bariatric Certified and Medical Director at Memorial Wellness Center.
This article appears in Winter 2024 December 2024.
