What is Public Health?

It's National Public Health Week.  Rather than just changing my Facebook profile pic or posting pix of the Empire State Building lit up in "team colors," I think awareness months and weeks should be used to educate people about the topic, not just reminding everyone that something exists.  (That's right all you blue-lit Empire State Bldg people with the puzzle piece profile pix, I'm looking at you.)  So, what is public health?

First, I'll tell you what it's not.  It's not about your personal health.  It's not about what goes on between you and your doctor, pharmacist, or insurance company.  We don't have records of that.  We don't want records of that.  It's none of our business.  I understand that you want your childhood medical records and your pediatrician closed up shop 20 years ago, but we simply do not have these things.  The government isn't nearly as Big Brotherish as some would lead you to believe.

Public health is about health issues that affect groups of people.  Environmental issues with drinking water or air pollution.  WIC subsidies for poor women who are pregnant or have young children.  Free cancer screenings for those who don't have insurance or can't afford to pay.  Health fairs.  Health education campaigns.  (You know all the quit smoking stuff you've seen over the years?  That's public health.)  Restaurant, hospital, and nursing home inspections.  Newborn biomedical and hearing screening.  Public safety.  Public policy.

Public health is about making changes and providing services that affect entire communities, not just one person.  Even programs like WIC and cancer detection programs that benefit individuals, also benefit the community as a whole by preventing bigger health care burdens down the road.  Early intervention programs for children with special needs, newborn biomedical screening for inborn errors in metabolism and other congenital problems, and newborn hearing screening to detect and address hearing problems at the earliest stage also benefit the community as a whole by attempting to give children the extra help they need long before they enter the school system.

In addition to providing specific services like education, screening, testing, detection, and inspections, public health workers also analyze aggregate data to help policymakers make decisions based on data trends and comparisons between different groups of people to see where help is and isn't needed so that scarce public funds are funneled in the right direction.  Data are used to track disease outbreaks.  Data are used to study the effectiveness of programs and policies on the population as a whole.  Leading causes of death are determined by statisticians in state health departments and in the National Center for Health Statistics.  Infant death, low birth weight and preterm birth percentages, and teen birth rates are all produced by public health departments.

Public health is large-scale and often long-term surveys of health-related behaviors.  Public health sets childhood growth chart standards and determines the BMI cut-offs between normal weight and overweight and between overweight and obese.  Public health is about using traumatic brain injury data to push for bicycle helmet and seat belt laws.  Public health is bioterrorism and natural disaster preparedness and response.  Public health is about lead and mold and other household things that can cause illness.  Public health is about asbestos and bloodborne infectious diseases and other occupational hazards.  Public health is immunizations to prevent the spread of communicable diseases and tracking and treating outbreaks when and if they do occur.

Public health is about all that and more.  I know a lot of people, myself included at times, like to come down on government and government employees.  We're sometimes portrayed as lazy, ignorant, and overpaid.  We're often confused with elected officials when people are poo-pooing "government."  Government employees are not elected.  We acquire and hold jobs just like people in the private sector.  The only difference is that everyone is privy to our salaries, our spending, and our mission, so they don't see how private companies squander money for their own profit.  But I digress.

Public health, in my opinion, is a noble profession.  We're not in it for profit or glory.  Our only mission is to help people with the one thing that we all have and need to maintain: our health.  Rich, poor, male, female, old, young, white, black, green, purple, we have health (hopefully good health) and we all need to maintain it in order to live long, happy lives.  As Count Rugen says in The Princess Bride, "If you haven't got your health, you haven't got anything."

For more information on National Public Health Week: http://www.nphw.org/

For more on the American Public Health Association: http://apha.org/

To learn more about the Centers for Disease Control and Prevention (CDC):  http://www.cdc.gov/

The CDC is the public health branch of the US Dept of Health and Human Services.

April is Parkinson's Disease Awareness Month

http://www.pdf.org/parkinson_awareness

About a dozen years ago, my uncle was diagnosed with Parkinson's Disease.  He has the classic tremor along with forward-flexed posture (camptocormia) and shuffling gait, small handwriting (micrographia), and depression.  A couple times when he's had medication issues, he has also suffered hallucinations, delusions, and anxiety. About 5 years ago, after a severe parasitic infection (babesiosis) and subsequent medication cross-reaction, he was diagnosed with dementia or Alzheimer's despite my mother's and my protests that there's no such thing as sudden onset Alzheimer's and that he had been perfectly fine mentally prior to the infection.  Luckily, it was "temporary dementia," in other words, he was misdiagnosed.  :)  My uncle is now 87 years old, stable on his medications, and living comfortably in a nearby assisted living facility.  His health is otherwise good and he'll probably outlive all of us.  

About 4 years ago, my father was also diagnosed with Parkinson's Disease after a period of just not feeling "right."  He does not have much of the classic Parkinson's tremor.  What he does have, instead, is nearly every other symptom of Parkinson's Disease.  These include slowness of movement (bradykinesia), postural instability, shuffling gait, decreased arm-swing while walking, dystonia, soft speech (hypophonia), swallowing problems (dysphagia), fatigue, a mask-line facial expression (hypomimia), difficulty rolling in bed or rising from a seated position, impaired fine motor dexterity and motor coordination, impaired gross motor coordination, an unpleasant desire to move (akathisia), memory problems, depression, anxiety, sleep disturbances including excessive daytime somnolence and nighttime insomnia, extreme constipation, and double vision.  Additionally, he has developed Levodopa-induced dyskinesia (think Michael J. Fox wobbling around) after several years on that medication.

To make matters worse, my father broke his hip about 10 years ago.  He had it repaired at the time and then replaced a couple years ago.  He suffered hallucinations in the first few days after replacement surgery, probably due to an interaction between his Parkinson's medications and either anesthesia or pain meds.  In the end, the hip replacement worked wonders and made him more comfortable than he had been in years.  Then, this past fall, he hurt his back while raking leaves.  Turns out he had age-related spinal deterioration and just moved the wrong way while raking leaves and tweaked it into a painful position. After trying therapy for a couple months, he had back surgery in February which again worked wonders and took him from extreme pain to virtually no pain overnight.  Having learned from the hip replacement hospital experience, my mom was able to better prepare the nursing staff and monitor his medication timing during this hospitalization and thus avoided hallucinations and other crap that someone without Parkinson's wouldn't have to worry about.  

The subacute (rehab) hospital has been another story.  See, with Parkinson's, medication timing has to practically be down to the minute.  Meds have to be taken 30 minutes before or one hour after eating so that they are properly absorbed in the body.  Each dose lasts a few hours with improvement seen soon after taking the dose with a peak period a couple hours later, followed by the medication wearing off before the next dose is due.  This means that not only does medication administration have to be coordinated with meal times, but also with physical therapy as it's useless to try to get a Parkinson's patient to do therapy in a "down time" in the medication cycle.  He needs to do therapy at his peak times or forget it.  Despite numerous reassurances by the rehab staff that they understand Parkinson's, they don't.  Every couple days, my mom has a talk with the nurse on duty and my dad has everything timed properly for a couple days.  Then it gets shot to hell until she has another talk with them.  Thus, it's been a rollercoaster ride for my dad.

A few days before he was due to be sent home, having gotten to the point where he could walk up a double flight of stairs unassisted and walk down holding the handrail, he got up in the middle of the night (without calling for assistance like he was supposed to), fell, and "cracked" his hip.  Sort of like tapping a hard-boiled egg but not breaking the shell... that's what he did to his bone.  No surgery required but now he's back to only doing a toe touch with that leg and has added at least 2 weeks onto his rehab stay.  Needless to say, he is miserable.  My mom is also miserable because she's been driving 25 miles each way nearly every day to visit him (and keep the staff in line) since he went to the rehab about 5 weeks ago.  I should mention that my mother is 78 years old and has a pacemaker and thyroid disease.  My dad is "only" 70.  He's due to be released in 10 days (assuming continued progress and no more mishaps) and my mom has no idea how she's going to handle him.  That will be a story for another blog post.

Bottom line:  While my dad probably still would've had the hip replacement and the back surgery, the recovery from both would have been markedly easier and simpler if he didn't have Parkinson's, which is essentially a movement disorder, to contend with.  Parkinson's sucks and makes everything else that's sucky suck more.  Unless you're Michael J. Fox.  He says Parkinson's is the best thing that ever happened to him.  God bless 'im.