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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
A civically minded approach to public health, perfect for students on any career path Understanding the Science and Practice of Public Health is an exciting new textbook designed specifically for introductory public health courses at the college level. In a world rapidly being challenged by climate change, starvation, water shortages, and epidemics--and in a nation plagued by obesity, diabetes, early onset cardiovascular disease, cancer, and gun violence--this book provides students with crucial information that they'll need to understand what's going on around them. Thematically, this book focuses on the viewpoint that "We the People" have the ultimate responsibility to collectively assure the conditions that allow people to successfully seek health and well-being. Public health is a public responsibility (a maxim often repeated in the book), and college and university students must be fully informed to optimally meet this vital civic obligation. Written to be accessible to students in any major, this unique text prepares students to participate in the daily actions needed (including advocacy and support of health-related regulations and policy) to become participants in public health practice, rather than passive recipients. Readers will: * Get an accessible introduction to the most pressing public health issues of today * Learn how public health is promoted in society using real-world examples * Become knowledgeable about public health so you can make informed decisions at the voting booth and in daily life * Discover the practice of public health as it applies to pandemics, substance abuse, climate change, gun violence, and more The science and practice of public health depends on a well-informed and highly engaged population of civic-minded adults. This book will enable students' enthusiastic participation in savings lives and promoting health--no matter what career path they decide to pursue.
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Table of Contents
Cover
Title Page
Copyright
FOREWORD
PREFACE
CHAPTER 1: THE COVID‐19 PANDEMIC: A PORTRAIT OF AN EPIDEMIC
Overview
Basic Terminology
A Brief History of the COVID‐19 Pandemic
Understanding Disease Transmission the Chain of Infection
How Do Vaccines Work?
Self‐Interests in Government and Racial Disparities in the Era of COVID‐19
Corporate Interests and the Spread of COVID‐19
A Few Thoughts About the Future of COVID‐19 and Other Emergent Diseases
Review and Key Terms
For Practice and Class Discussion
References
CHAPTER 2: CHANGING LIVES A “MILLION AT A TIME”: PUBLIC HEALTH IS VERY DIFFERENT THAN THE MEDICAL PROFESSION
Overview
The Need for Organized Public Health Practice
Three Tenets of Public Health
What Are the Tools of Public Health Practice?
The Role of Public Health Research
Why Is Public Health So Important?
Review and Key Terms
For Practice and Class Discussion
References
CHAPTER 3: THE EVOLUTION OF PUBLIC HEALTH PRACTICE
Overview
An Early Origin of Public Health Practice
The Rise and Fall of Local Health Departments
Embracing Actual Causes of Death
Shifting the Mean
The Scope of Public Health Practice
Review and Key Terms
For Practice and Class Discussion
References
CHAPTER 4: HOW DOES PUBLIC HEALTH WORK? THE EXAMPLE OF TOBACCO CONTROL
Overview
The Effects of Tobacco Use on the Human Body
Understanding the California Tobacco Control Program
Key Principles of the Master Settlement Agreement
The U.S. Vaping Epidemic: The Tobacco Industry Strikes Back
What Are the Public Health Lessons Stemming from Tobacco Control?
Review and Key Terms
For Practice and Class Discussion
References
CHAPTER 5: AMERICA’S OBESITY AND CARDIOVASCULAR DISEASE EPIDEMICS: POSSIBLE PUBLIC HEALTH SOLUTIONS
Overview
The Magnitude of the CVD and Obesity Epidemics
Metabolic Syndrome and Its Four Factors
Obesity Is Contagious
Regulating the Food Industry
Emerging Programs That Promote Improved Population‐Level Nutrition
Sitting Is the New Smoking
Promoting Daily Movement and Exercise
A Cautionary Note: Preventing CVD and Obesity Involves People Making Lifetime Commitments
Review and Key Terms
For Practice and Class Discussion
References
CHAPTER 6: PREVENTING DIABETES: A PUBLIC HEALTH PRIORITY
Overview
Glucose Metabolism, Insulin, and the Pancreas
Diabetes Develops Day By Day
Examples of How U.S. Sugar Consumption Can Be Reduced
The Burden of Type 2 Diabetes on the Health‐Care System
Review and Key Terms
For Practice and Class Discussion
References
CHAPTER 7: AVERTING CANCER RATHER THAN WAITING TO TREAT IT
Overview
A Hygeia‐Based Philosophy for Cancer Control
Public Health Opportunities to Prevent Colorectal Cancer
Public Health Opportunities to Prevent Breast Cancer
Public Health Opportunities to Prevent Cervical Cancer
The Integration of Public Health and Medical Care
Review and Key Terms
For Practice and Class Discussion
References
CHAPTER 8: EXCESSIVE ALCOHOL USE: HOW CAN IT BE REDUCED AT A POPULATION LEVEL?
Overview
The U.S. Burden of Excessive Alcohol Use and the Biological Process of Alcohol Metabolism
Alcohol Has Long‐Term Effects on the Liver
The Impact of Alcohol Use on the Cardiovascular System
Population‐Level Strategies to Reduce Overall Alcohol Consumption
Socially Oriented Intervention Approaches
Review and Key Terms
For Practice and Class Discussion
References
CHAPTER 9: SOLVING THE U.S. OPIOID CRISIS: A PUBLIC HEALTH CHALLENGE
Overview
A Brief History of the Crisis: Why Did It Happen?
The Crisis Is More Than Just Overdose
America's Hepatitis Epidemic
Harm Reduction Applied to the Opioid Crisis: Syringe Service Programs
The Value of Methadone and Other Treatments
Why Does “Place” Matter?
What Does the Future Look Like for the Opioid Crisis?
Review and Key Terms
For Practice and Discussion
References
CHAPTER 10: HIV IN THE UNITED STATES – WHAT ELSE CAN WE DO?
Overview
Fundamental Aspects and Terminology of the Disease Process for HIV
The Medical Approach to HIV/AIDS
What Is Biological Synergy with Respect to HIV Transfer?
Applying Social Science to HIV Intervention
What Is Prevention Case Management?
Examples of Harm Reduction Applied to HIV/AIDS
A Delicate Balance
Review and Key Terms
For Practice and Discussion
References
CHAPTER 11: PREVENTING GUN VIOLENCE AND PROMOTING HIGHWAY SAFETY: A STUDY OF STARK CONTRASTS
Overview
Gun Violence Is a Pervasive Public Health Problem
What Is a Quality‐Adjusted Life Year?
Approaches to Reducing Gun Violence
The American Myth of “Self Defense”
The Social Aspect of Gun Violence
Trends in U.S. Automobile Collisions and Injuries
Regulatory Actions Applied to Highways
Regulations Applied to Automobile Manufacturing
Similarities and Contrasts Between Controlling Gun Violence and Controlling Traffic Fatalities/Injuries
Review and Key Terms
For Practice and Class Discussion
References
CHAPTER 12: CLIMATE CHANGE: THE IMPORTANCE OF WATER
Overview
The Meaning of a Global Public Health Problem
Basic Causes of Climate Change and the Global Water Crisis
Solutions Based on Reducing Consumption
Solutions Based on the Reuse of Water
Applying the Four Pillars of Public Health to Protecting Water
Key Terms and Review
For Practice and Class Discussion
References
CHAPTER 13: CLIMATE CHANGE: IMPLICATIONS REGARDING FOOD
Overview
Food Insecurity in America
Macro‐Level Influences Leading to Climate Change
Climate Change–Induced Food Shortages Create Health Disparities
Climate Change Is Both a Cause and a Consequence of the Global Food Crisis
Will Farming Practices Change in Response to a Warming Planet?
Small Changes Add Up
A Plant‐Based Diet Provides Ample Protein
Review and Key Terms
For Practice and Class Discussion
References
CHAPTER 14: OVERPOPULATION AND THE PREVENTION OF UNINTENDED PREGNANCY
Overview
Understanding the Malthus Hypothesis
The S‐curve and the J‐curve
Reduced Population Growth Is Possible
Why Is the Widespread Education of Girls Important to Population Control?
The Role of Males in Controlling Population Growth
Understanding Death Rates
What About the Future?
Review and Key Terms
For Practice and Class Discussion
References
CHAPTER 15: EMERGING DISEASES AND THE NEED FOR VACCINE RESEARCH
Overview
Learning from the History of Smallpox and HIV
Vaccines Have Already Eliminated Some Diseases in the United States
Emerging Diseases of Concern
Examples of Effective Public Health Systems
The Delicate Balance of Life
Review and Key Terms
For Practice and Class Discussion
References
ANNOTATED ANSWERS TO PRACTICE QUESTIONS
EPILOGUE
Reference
End User License Agreement
List of Tables
Chapter 2
Table 2.1 Useful terms and meanings from the science of epidemiology.
Table 2.2 Critical differences between medical care and public health.
Chapter 4
Table 4.1 Cancers having tobacco tar as a cause or a contributing factor.
Chapter 5
Table 5.1 Sodium content of typical foods
Table 5.2 What should people look for on food labels?
Chapter 7
Table 7.1 Chemopreventive phytochemicals pertaining to colorectal cancer
Table 7.2 Food sources of antioxidants
Chapter 8
Table 8.1 Examples of chronic conditions caused by excess drinking
Chapter 10
Table 10.1 Selected opportunistic illnesses that may lead to death
Chapter 13
Table 13.1 Feed conversion ratios (based on the edible weight of the animal)...
Table 13.2 Average percent price increase of selected foods, 2019–2021
Table 13.3 Land required (in square meters) to produce one kilogram of food...
Table 13.4 Sample of available proteins in common plant‐based foods.
Chapter 14
Table 14.1 Common mistakes people experience when using condoms
List of Illustrations
Chapter 1
Photo 1.1 College students quickly became accustomed to the idea of mandator...
Photo 1.2 People who took the time to understand that even small children co...
Figure 1.1 How agents, hosts, and environments interact
Figure 1.2 The cycle of propagated disease
Photo 1.3 Personal protective equipment takes the concept of masking to its ...
Photo 1.4 Vaccine hesitancy became a new term for Americans as a result of t...
Photo 1.5 White‐tailed deer are abundant in many parts of the United States;...
Figure 1.3 The racial and ethnic divide with COVID‐19 hospitalization and de...
Chapter 2
Photo 2.1 At one time, this was the only way most people could obtain water....
Figure 2.1 The difference between public health and medical care
Photo 2.2 A typical DUI‐related traffic accident leaves its mark on the worl...
Figure 2.2 The basic tools of public health practice
Photo 2.3 Soda sales comprise a large share of business of grocery stores.
Photo 2.4 The Atlanta beltline attracts people of all ages who want to be ou...
Chapter 3
Photo 3.1 In the United States and throughout the world, rats are a leading ...
Photo 3.2 The pasteurization of milk is now a public health practice that mo...
Photo 3.3 The 1918 influenza epidemic infected approximately one‐third of th...
Photo 3.4 Local health departments are important assets for larger public he...
Figure 3.1 A depiction of the Health Belief Model
Figure 3.2 The example of sodium consumption as an important actual cause of...
Photo 3.5 Saving people from raging waters will never be as easy as preventi...
Chapter 4
Figure 4.1 Components of the California Tobacco Control Program
Photo 4.1 Stores that sell cigarettes and other tobacco products are subject...
Photo 4.2 The smoke emanating from ashtrays contains a higher level of carci...
Photo 4.3 The CDC has created large‐scale campaigns to keep pregnant women f...
Photo 4.4 This article described the evaluation of a school‐based smoking ce...
Photo 4.5 Smoking with friends is a reinforcing social experience.
Figure 4.2 The stages of change involved in the transtheoretical model
Figure 4.3 Tobacco product use among high school students.
Figure 4.4 Market economy vs. a focus on health and welfare
Chapter 5
Figure 5.1 Plaque accumulation on the walls of a coronary artery
Photo 5.1 A typical 8‐ounce can of green beans is two servings of half a cup...
Photo 5.2 This entire food is highly nutritious – both the root and the leav...
Photo 5.3 T typical daily bounty from a home garden in New England
Photo 5.4 Home canning tomatoes is a common method of preserving summer’s bo...
Figure 5.2 Tenets of the farm‐to‐table movement in America
Figure 5.3 A visual depiction of wellness
Chapter 6
Figure 6.1 A simplified diagram of carbohydrates
Photo 6.1 High fructose corn syrup is just another name for sugar!
Photo 6.2 Foods loaded with sugar – and sugar itself – are eligible for purc...
Photo 6.3 Your daily diet probably includes this much sugar or more.
Figure 6.2 The rising direct medical costs for diabetes care in the United S...
Photo 6.4 Somehow chocolate is culturally linked to love and romance.
Chapter 7
Photo 7.1 We still build huge monuments to Laso and Aceso.
Figure 7.1 Risk factors are not the same as protective factors
Photo 7.2 Beans are among the least expensive foods sold in stores, but they...
Photo 7.3 Fresh blackberries are a great way to enjoy your daily dose of ant...
Figure 7.2 The progression of cervical cancer
Figure 7.3 HPV vaccination model
Figure 7.4 Example of a research‐tested intervention from the National Cance...
Chapter 8
Figure 8.1 A simplified illustration of alcohol metabolism
Photo 8.1 This infographic from the CDC punctuates the need to intensify pub...
Photo 8.2 This infographic from the CDC (CDC, 2022b) provides a visual image...
Figure 8.2 The mediating role of social norms on the relationship between de...
Figure 8.3 An example of the rose curve applied to alcohol use
Photo 8.3 Neighborhood bars feature local taps and serve beer and other drin...
Figure 8.4 The positive feedback cycle of reciprocal causation applied to al...
Chapter 9
Photo 9.1 Within two years after his untimely death, it was determined that ...
Figure 9.1 The role of fentanyl in the rapid escalation of overdose death ra...
Photo 9.2 Known as needle tracks, these tell‐tale marks are common among per...
Figure 9.2 A graphic depiction of terminology relative to disease spread amo...
Photo 9.3 CDC campaigns to promote hepatitis C screening typically feature p...
Figure 9.3 The rising tide of hepatitis C cases in the United States
Figure 9.4 Case rates of hepatitis C are not equally distributed
Figure 9.5 What will the next 10 years look like?
Photo 9.4 Once considered illegal drug paraphernalia, this bong gives a soci...
Chapter 10
Photo 10.1 Queen lead singer Freddie Mercury.Source: rayyan/Adobe stock.
Figure 10.1 The continuum of care: a method of preventing HIV transmission...
Figure 10.2 Increasing STI rates in the United States
Photo 10.2 This is a photo of a chancre caused by syphilis, located on the h...
Figure 10.3 An overview of two complementary approaches to HIV prevention
Figure 10.4 Pathways within the information‐motivation‐behavioral skills (IM...
Photo 10.3 The CDC Compendium of Effective HIV Prevention Programs is easy t...
Photo 10.4 This recruitment poster reads, “Are you covered in case of an acc...
Chapter 11
Photo 11.1 Indiana is only one of many states that freely allow any adult to...
Photo 11.2 If gun violence was a contagious disease, the pathogen would be t...
Photo 11.3 Toxic masculinity is a root cause of the American gun violence cr...
Figure 11.1 This headline appeared on Memorial Day in the wake of the gun ma...
Figure 11.2 Generally, the U.S. rate of death from automobile collisions has...
Photo 11.4 The National Highway and Traffic Safety Administration invests he...
Photo 11.5 Intensive research is the basis for posted speed limits.
Figure 11.3 Unlike gun violence, auto fatalities have a large impact on whit...
Chapter 12
Figure 12.1 Americans are not exempt from the global water crisis
Photo 12.1 Mount Sopris is located near Carbondale, Colorado. Its snowpack i...
Photo 12.2 This Colorado stream transports snowmelt from the higher elevatio...
Photo 12.3 Because rain is sparse in many western states, farmers rely on sn...
Figure 12.2 Small acts by millions of people always make a big difference...
Photo 12.4 Trees, grass, and flowers all bind carbon, thus helping to slow g...
Figure 12.3 The demand‐supply‐waste model
Figure 12.4 Be sure your home or place of residence has toilets with this la...
Figure 12.5 Each week, the CDC features leading public health news, such as ...
Photo 12.5 Raw sewage will become reclaimed water, with sludge as a by‐produ...
Chapter 13
Photo 13.1 Cattle ranches of 1,000 acres or more are common in the United St...
Photo 13.2 Dairy cows are the source of milk, cheese, butter, yogurt, and ic...
Photo 13.3 Farmers plow millions of acres annually, releasing large volumes ...
Photo 13.4 Plants such as peas “fix” nitrogen into edible protein for humans...
Photo 13.5 Bees give us food!
Figure 13.1 In 2022, America’s progress toward slowing climate change was al...
Photo 13.6 The price of food could further divide the American people.
Figure 13.2 A cycle of dependence on costly medical care
Figure 13.3 A national model of food recovery
Photo 13.7 Summer fairs, carnivals, concerts, and farmer's markets typically...
Chapter 14
Figure 14.1 The S‐shaped curve of population growth, plotted against carryin...
Figure 14.2 The J‐shaped curve of population growth, showing the rapid escal...
Photo 14.1 In heavily urbanized areas, even outdoor spaces can pose a risk o...
Photo 14.2 Many urban waterways, such as the Hudson River, are far from the ...
Figure 14.3 The relationship between overpopulation, deforestation, and clim...
Photo 14.3 An inexpensive but worthwhile form of public health intervention ...
Photo 14.4 Condoms may be the answer to the long‐term survival of the human ...
Chapter 15
Photo 15.1 The CDC's Morbidity and Mortality Weekly Report (MMWR) is part of...
Photo 15.2 The eradication of smallpox occurred nearly 200 years after the d...
Figure 15.1 A necessary chain of public health actions to control emerging d...
Photo 15.3 Anti‐vaxxers typically have a long list of vaccines that they opp...
Figure 15.2 For decades, the public had been receiving these vaccines during...
Photo 15.4 A public health worker during the 2014 West African outbreak of E...
Photo 15.5 In her detailed introduction to the global problem of emerging di...
Photo 15.6 The Peace Corps has been devoted to improving public health since...
Figure 15.3 Essential public health tools in the balance of power over micro...
Epilogue
Photo E.1 The author's grandson.
Guide
Cover
Table of Contents
Title Page
Copyright
FOREWORD
PREFACE
Begin Reading
ANNOTATED ANSWERS TO PRACTICE QUESTIONS
EPILOGUE
End User License Agreement
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Understanding the Science and Practice of Public Health
Richard Crosby
Good Samaritan Endowed Professor College of Public Health University of Kentucky
Copyright © 2023 by John Wiley & Sons, Inc. All rights reserved.
Published by John Wiley & Sons, Inc., Hoboken, New Jersey.
Published simultaneously in Canada.
No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permitted under Section 107 or 108 of the 1976 United States Copyright Act, without either the prior written permission of the Publisher, or authorization through payment of the appropriate per‐copy fee to the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, (978) 750‐8400, fax (978) 750‐4470, or on the web at www.copyright.com. Requests to the Publisher for permission should be addressed to the Permissions Department, John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, (201) 748‐6011, fax (201) 748‐6008, or online at http://www.wiley.com/go/permission.
Trademarks: Wiley and the Wiley logo are trademarks or registered trademarks of John Wiley & Sons, Inc. and/or its affiliates in the United States and other countries and may not be used without written permission. All other trademarks are the property of their respective owners. John Wiley & Sons, Inc. is not associated with any product or vendor mentioned in this book.
Limit of Liability/Disclaimer of Warranty: While the publisher and author have used their best efforts in preparing this book, they make no representations or warranties with respect to the accuracy or completeness of the contents of this book and specifically disclaim any implied warranties of merchantability or fitness for a particular purpose. No warranty may be created or extended by sales representatives or written sales materials. The advice and strategies contained herein may not be suitable for your situation. You should consult with a professional where appropriate. Further, readers should be aware that websites listed in this work may have changed or disappeared between when this work was written and when it is read. Neither the publisher nor authors shall be liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages.
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Library of Congress Cataloging‐in‐Publication Data applied for:
9781119860921 (Paperback); 9781119860945 (Adobe PDF); 9781119860938 (ePub)
Cover and Author Image: Courtesy of Richard Crosby
Cover design: Wiley
FOREWORD
Public health is about creating the conditions for population health. This conceptualization is memorized by all public health students but misunderstood by them and everyone else. Why? Because true comprehension necessitates action and risks upending the arrangement of power in our world. These power structures are the very ones that create the maldistribution of deleterious health outcomes through, for example, environmental catastrophes, economic inequalities, and approaches to globalization.
As an academic who is highly engaged in public health practice, devoting a career to working in public health trenches throughout the world, I have witnessed firsthand the circumvention of important structural issues in favor of protecting power and wealth – whether communities, corporations, countries, or regions. In my work, this happened with HIV and other bloodborne infections, and opioid overdose.
Talking about these issues within the public health community and writing words such as these in public health textbooks are futile endeavors because, as shown during the COVID pandemic, the public health profession is subjugated by the power structures and cannot activate the levers of change. I was reminded of this when I had to admit my surprise that we could not use the podium given to public health to advocate for systemic change during the initial COVID period (2020–2021). Public health remains anemic in effecting climate change, drought, or water scarcity – topics that, strangely, are viewed as being out of public health's “lane.” This is likely because public health is speaking to itself.
Our lives and the continuation of our species and our world depend on our collective ability to address root causes of the conditions affecting population health. To do this, we must become an educated electorate. This means fighting for enfranchisement from Gulfport, Mississippi USA to Yangon, Myanmar. This means understanding how law and policy affect the structures and behaviors of systems impacting health outcomes at the population level. This is not about healthcare or pharmaceutical access, although they too are products of the maldistribution of power. This means getting involved in the politics of our communities, states, and countries.
A central lesson is that those who own the framing of a problem (problem definition) determine the playing field for problem solving, the solution options, the actors who have standing for involvement, and the distribution of resulting benefits and burdens. If, for example, the water crisis in the western United States is just a matter of individual water use, then the range of interventions to increase the supply is at the individual or family/household level. But if water scarcity is a function of unbridled development, factory farming, and the inability of the U.S. national government to facilitate solutions with corporations and state and tribal governments, then the options for interventions are quite different.
Let's be honest. Public health colleges, schools, and programs do not prepare students for this level of work. Policy curricula have only been required to accredit U.S. schools of public health in the last 10 years. Public health's professional penchant for individual‐level behavioral interventions blinds us to the real fact that it is on the structural level that we must focus, because our lives depend on it.
In this book, Dr. Crosby opens a vital window to our future with a focus on upstream approaches to population health. Readers will recognize critical issues such as COVID, chronic disease, and water scarcity. They will learn (or perhaps recall) civics lessons about the policies and political processes that determine the structure and functioning of government: policies and systems that, for example, facilitate gun violence by precluding meaningful action. Timing is of the essence because as I write this, the United States has experienced its 609th mass shooting yet this year, and Haiti and Mexico reel under gun violence fueled by U.S. gun manufacturers.
The take‐home message of this book is that public health is centrally political because it addresses the structures that create the conditions for health. Public health is about restoration, justice, and reparation. It is about righting the boat so that we can, together, weather the stormy seas. It is proactive, preventive, population‐wide, and courageous. It is about changing our world so that we can, as present and future populations, thrive.
So as you encounter this book and the concepts within, make a promise to yourself that you will take action. You will become a change agent. You will embrace the fact that we the people make the policy – but only if we get involved and fix our broken systems. The days of intense focus on individual‐level information campaigns have yielded to a new generation of efforts leveraging public support and engagement for the protection of a basic human right: to live healthy and long lives!
Beth Meyerson, MDiv., PhD
Professor of Medicine
Department of Family and Community Medicine
College of Medicine
University of Arizona
PREFACE
When the term civics is used in the context of education, most students and teachers in the United States think about the process of learning about the Constitution, the Bill of Rights, co‐equal branches of the federal government, and the relationship of state governments to the larger functioning of the nation. Often, however, the approach to civics is less than applied, and the lessons may come across as irrelevant to students. It frequently is not apparent that governments – at all levels – are very much involved in one aspect of our daily lives: promoting and protecting the health of the public. With the year 2020 ushering a global pandemic into the lives of Americans, the term public health quickly became used in everyday language, the media, and the offices and meeting rooms of state and federal elected representatives. For most Americans, this was the first time in their lives that public health was not taken for granted.
The COVID‐19 pandemic is just one small example of the threats and corresponding public health challenges that can best be met through the collective action of our society. In contrast, 50 years ago, the approach to public health was tightly focused on personal behavior change. This approach originates in medical care and thus is limited to personal actions tied to the ongoing process of monitoring people for the development of chronic diseases and vaccinating people against infectious diseases. The “consult your doctor” advice is all too often a catchphrase used under the rubric of prevention. As the nation has evolved, so has our ability to transcend the limits of medical care and truly embrace the concept of health for all (including those without medical care). Decades of funded research have taught the lesson of health being an outgrowth of how we live our lives rather than a product paid for through medical bills.
At this time in history, our nation has an advanced capacity to be proactive about preventing both infectious and chronic diseases at the level of the entire nation (known as population health). The approach to population health transcends the personal level and places the responsibility to prevent disease on communities, industries, employers, local and state governments, and the U.S. federal government. This proactive approach functions at a population level as a consequence of an informed and educated electorate – meaning that “we the people” collectively help to shape and maintain the conditions that promote health for all people. This is necessary because the most urgent threats to the health of the public – many of which are results of climate change – demand large‐scale adaptations, including immediate actions to reduce the looming health disparities that have plagued America for too long.
As a professor of public health for several decades now, I have carefully selected only the most urgent issues for your attention in this textbook. You will find that each chapter is written with an emphasis on the present and the future as opposed to dwelling on the past. The chapters form a type of unfolding story that begins with how public health has skyrocketed to the center of attention and continues through the issues most in need of – and most amenable to – a prevention‐oriented solution, as opposed to the high price of waiting for a clinical disease to develop before intervention occurs. An underlying theme of this textbook is that America must lessen its dependence on medical intervention and become increasingly vigilant about keeping all people from developing risks that lead to premature morbidity and mortality. The last four chapters are particularly novel and important because each is cast as a type of blueprint to design public health responses to events that have yet to become fully catastrophic. We must act now to protect global health in the future!
CHAPTER 1THE COVID‐19 PANDEMIC: A PORTRAIT OF AN EPIDEMIC
LEARNING OBJECTIVES
Appreciate and explain the history of the COVID‐19 pandemic.
Understand disease transmission and the
chain of infection
and how this can be altered to protect the public.
Explain basic principles of infection and disease transmission.
Describe the function of vaccines.
Explain how self‐interests in government can hinder public health efforts to control the spread of infectious diseases.
Describe examples of corporate interests that overshadowed public health efforts to control COVID‐19.
Using COVID‐19 as an example, articulate how epidemics magnify racial and ethnic disparities in nations such as the United States.
The following is an excerpt taken from a speech delivered by President Barack Obama, in the White House, to an assembly of global health leaders. The excerpt begins by referring to recent global pandemics such as Ebola, H1N1, and SARS.
Each time, it's been harder than it should be to share information and to contain the outbreak. As a result, diseases have spread faster and farther than they should have – which means lives are lost that could have been saved.
—President Barack Obama, September 26, 2014
Overview
The last case of smallpox was diagnosed in 1977. The disease caused an estimated 300 million deaths over at least a thousand years, so this final diagnosis represents a milestone in public health practice. The milestone was achieved through one of public health's greatest assets: vaccination! So, it would seem that vaccines will solve everything related to global pandemics. If only this were true! The sobering reality is that Edward Jenner's pioneering work on the smallpox vaccine occurred more than 200 years before the disease was eradicated. The lesson that should have been learned from the globally coordinated smallpox vaccination campaign was that people – and even entire governments – are bound to resist vaccination, regardless of the potential consequences. The World Health Organization (a global entity that is widely recognized for being the world authority on the prevention and control of infectious disease) ultimately mobilized health workers to enter even the most remote and culturally unique areas of the planet to convince people to take the vaccine being offered to them at no cost. Sadly, this global smallpox vaccine campaign lasted more than 11 years and was fraught with conflict at the local level in nation after nation.
Now, let's fast‐forward to 2021, when healthcare workers around the world were assigned the task of entering remote and culturally unique areas of the planet to convince people to take the vaccine being offered to them at no cost. This time, it was a vaccine against COVID‐19. Sadly, populations were not universally glad to have this vaccine; millions of people refused it, despite ample evidence that death from COVID‐19 was approximately 11 times more likely among the unvaccinated than the fully vaccinated. This level of refusal was, of course, history repeating itself. But stark differences existed between smallpox vaccination campaigns and vaccination campaigns against SARS‐Cov‐2 (i.e., COVID‐19). With COVID‐19, the very same discussions healthcare workers were having with people in isolated tribal villages in Sierra Leone, for example, were also occurring in most U.S. states! Despite an overwhelming level of access to education, COVID‐19 vaccine information, and published evidence of the vaccine's safety records, millions of U.S. residents were asking questions such as, “Why should I trust the contents of this vaccine?” and “How do I know this will not give me COVID?” In short, massive uptake of the vaccine did not happen.
As the Delta variant of COVID‐19 emerged, it had a huge advantage: many unvaccinated people also were not wearing masks. Due to behavioral factors that were not rectifiable, these two very simple public health measures (vaccination and mask wearing) failed to protect the public. Consequently, hospitals continued to be overwhelmed with COVID patients, workforce productivity was slowed, supply chains were crippled, and economies worldwide slowly imploded under the constant strain of a pandemic that could have ended in record time.
two very simple public health measures (vaccination and mask wearing) failed
This chapter is not about the history of COVID‐19, nor is it about the host of blunders and mistakes made in terms of public health response. Instead, it uses COVID‐19 as an example of how public health practice can successfully control the spread of infectious diseases. As the only chapter in this textbook devoted to infectious disease, this topic comes first because controlling epidemics and pandemics is the very origin of public health practice.
As you study this chapter, you will learn basic principles pertaining to the spread and control of infectious diseases. To keep the discussion relevant and timely, each example will be applied to COVID‐19. You will also learn a bit about mutation and why, for example, the flu vaccine must be remade and redistributed annually. As the chapter continues, you will come to understand that COVID‐19 is not a “once in a lifetime” disaster. Rather, COVID‐19 should be viewed as a warning to all humans that our species exists in a fragile balance within a complex web of tiny microorganisms that ultimately can cause massive levels of death and turmoil. Learning to respect this balance and protect it through carefully planned standards of public health practice is an urgent priority for all of us.
All too often public health is taken for granted. The exception is when a nation or the entire world is in the midst of an epidemic or pandemic. Thus, a top priority of public health is the control of infectious disease. If you visualize public health practice as a pyramid, the base is first and foremost the control of rapidly spreading infectious diseases. Indeed, this goal is the origin of public health (see Chapter 2). This book also begins with this chapter because COVID‐19 teaches a lesson that should greatly inspire all of us: that “we the people” must have an advanced understanding of what may arguably be the most vital function of local, state, and even federal government: protecting the health of the people. Finally, as this is the only chapter in this textbook devoted to infectious disease, you will learn about the overall principles of disease transmission and control. These principles are more important than COVID‐19 per se because it is highly likely that many other life‐threatening infectious diseases will emerge in the coming decades (Beeler, 2021).
“we the people” must have an advanced understanding of what may arguably be the most vital function of local, state, and even federal government: protecting the health of the people.
Basic Terminology
Before you read any further in this chapter, it is vital to understand the implied meaning of several terms related to public health practice. The first, of course, is the word pandemic. COVID‐19 is correctly referred to as a pandemic because it is a global occurrence – thus, pandemics affect multiple nations and continents. When, however, referring to just one nation (such as Britain, China, or the U.S), it is appropriate to use the term epidemic. Epidemics are local, whereas pandemics are global. Although you may not be used to thinking about the United States as “local,” from a global perspective this is very much the case. Because of significant differences between governments, cultures, and the health status of people, it is useful to think about how, for example, one nation differs from another in terms of progress in controlling its local version of any given pandemic. A third term in this regard is endemic. History shows that most nations can eventually reduce the severity of an epidemic to a low and stable level of annual new cases. At that point, the disease causing that epidemic is correctly referred to as an endemic. Sadly, some epidemics reach an endemic level only after several years, or even decades, of public health intervention.
For now, three other terms are vital for you to understand. The first denotes any microorganism having the ability to invade the human body and trigger a disease process: this is a pathogen. A pathogen may or may not be a living cell in its own right. COVID‐19 is caused by a virus. A virus is not a living cell. Instead, it is a set of genetic instructions looking for cells to invade so it can carry out these instructions. The next term is immunity. Without immunity to pathogens, humans would quickly perish. Immunity is typically acquired based on the invasion of a given pathogen followed by a successful immune response. It is very much the case, by the way, that your immune system is your lifeline to survival. Immunity to a specific pathogen can also be acquired through the artificial means of vaccination. When a pathogen invades the immune system (or, in the case of vaccines, when the properties of the vaccine enter the body) and the immune system functions properly, the result is the development of antibodies. Depending on the pathogen and the immune system, antibodies may last for a lifetime, several years, or even less than one year. Antibodies maintain a person's health in the near‐constant presence of pathogens in daily life.
A Brief History of the COVID‐19 Pandemic
In December 2019, stray – and very brief – snippets of the news described a new virus affecting the respiratory systems of people in China. The news was not particularly disturbing or by any means alarming to most people in the United States. In less than two short months, however, all that changed. The virus was quickly gaining traction worldwide, and the United States was far from exempt (as it had been for so many other pandemics that were quickly controlled and soon extinguished). By March 2020, news programs were heavily invested in covering what was then widely known as the COVID‐19 pandemic. For the first time in the lives of most Americans, a well‐deserved fear penetrated daily life, and it was clear that an era of isolation, mask wearing, and hopes for a vaccine or cure had begun. Stores, restaurants, and business establishments posted signs such as “Temporarily closed.” People employed in careers that allowed online work shifted their job site to their living room or den, while those without this ability became unemployed or risked exposure to the new virus on a regular basis. Many others lost their jobs due to shutdowns in the service industries (restaurants, hair salons, retail stores, and so on). Food kitchens and homeless shelters were both overwhelmed and unprepared to meet the rush in demand in ways that were “COVID‐safe.” The world had dramatically changed in just a few short months.
The world had dramatically changed in just a few short months.
By the end of 2021, it was clear that the U.S. death toll for COVID‐19 would soon surpass the milestone 1 one million people. The worldwide myth – emanating from developed nations such as the United States – that any infectious disease could be controlled had been shattered by COVID‐19. As public health became an everyday term, the public health system became exposed as a tattered web of loosely arranged puzzle pieces that would not fit together in any meaningful way. The public health response was largely a failure. This is not to imply that great measures were ignored; indeed, thousands of institutions – from universities to Fortune 500 companies such as Google and Microsoft – created highly protective policies. University students and their professors, for example, became accustomed to classrooms characterized by mandatory mask rules (see Photo 1.1). Even when some of the mandates were removed, millions of Americans erred on the side of caution and continued to wear masks in places such as grocery stores (see Photo 1.2).
Photo 1.1 College students quickly became accustomed to the idea of mandatory mask use during all classes that were held in person as opposed to online.
Photo 1.2 People who took the time to understand that even small children could carry and thus transmit the virus were quick to insist that their own children (or grandchildren) must “mask up.”
Although most people who lived through the early years of the COVID‐19 pandemic probably have their own version of this space in U.S. history (see Box 1.1), histories of pandemics are best written by science reporters. For instance, Debora MacKenzie (MacKenzie, 2020) wrote an entire book about why the COVID‐19 pandemic “never should have happened.” Early in the book, she recounts the events of December 31, 2019. She began the day by reading a report from a prominent organization known as ProMED (Program for Monitoring Emerging Diseases). The report described people with “severe, undiagnosed pneumonia in the central Chinese city of Wuhan, in Hubei province” (MacKenzie, 2020, p. 3). This should have been a wake‐up call to the world, but instead it was barely noticed. As it turned out, that day was the unofficial start of what became the largest pandemic since AIDS (a pandemic yet to be fully controlled).
Before COVID‐19, scholars and historians frequently referenced a pandemic less recent than AIDS. In 1918, Americans were suddenly in the midst of what became known as the Spanish flu pandemic. The flu is a virus; however, unlike COVID‐19, it is capable of dramatic shifts in the proteins of its surface structure and DNA. The 1918 flu was a result of an unlikely shift that led to the death (often in just one or two days) of approximately 675,000 Americans in less than 2 years. Prior to COVID‐19, this 1918 epidemic was considered the worst in modern U.S. history. Despite warnings from prominent scientists (Garrett, 1995), the world remained largely unprepared for a repeat of the 1918 tragedy. Then, just over 100 years later, the novel coronavirus came along. This was significant because it altered the public illusion that somehow modern medicine would “protect us all.”
Unlike COVID‐19 (at least for now), Spanish flu was a pandemic of great virulence, with people becoming ill in the morning and dying by nightfall. This rapid destruction of the hosts by the virus led to an equally rapid decline in the pandemic: the virus kept destroying its reservoir (i.e., people) so quickly that infected people had little chance of spreading the disease before they died.
After the Spanish flu pandemic, nations worked together to construct safeguards against future pandemics. But even despite recent warnings from public health experts whose careers were focused on global preparedness against pandemics, the Trump administration (2016–2020) largely dismantled many of the global protections put in place by the previous administration under President Obama (2008–2016). When Americans found themselves in the midst of the COVID‐19 pandemic, the broadly ignored global protections were sorely missed. Consequently, variants of COVID‐19 such as the Delta variant and the Omicron variant were able to spread rapidly through the world. A variant is nothing more than a random mutation of viral replication, one that successfully creates new properties of a virus that can then propagate.
BOX 1.1. ONE SCHOLAR'S PERSPECTIVE ON THE COVID‐19 PANDEMIC
While authoring multiple textbooks over two decades, it has always been my practice to avoid writing in the first person. I will violate that rule for only this particular box! As a professor of public health who specialized in the control of HIV, I was immediately struck by the vast similarities between the early years of the HIV pandemic and the first two years of the COVID‐19 pandemic. Even before HIV was named, the public experienced a type of mass hysteria, and misinformation spread quickly and rapidly became “fact” in the eyes of people who had a need to embrace beliefs about HIV that best fit their worldview. Homophobic people, for example, were quick to dismiss HIV as a “gay disease.” People who viewed drug addiction as a personal choice were quick to view HIV transmitted through the reuse of needles/syringes as an outcome of moral weakness. It wasn't until children became infected by HIV (through blood transfusions or by mother‐to‐fetus/infant transmission routes) that people could no longer dismiss HIV as being segregated to “bad people.” It was soon clear to me that COVID‐19 and HIV were strikingly dissimilar because rather than “bad people” dying, the preponderance of people killed by COVID‐19 were 70 years of age and older. Yet this dissimilarity created a parallel to the HIV pandemic because young and middle‐aged people freely engaged in the belief pattern of “it won't hurt me.” This was to me a repeat of all the work I had done in public health since 1983 – people almost always found a way to engage in denial of risk so they would not have to alter their behaviors. Examples include people who smoke, remain obese, and consume high‐sodium diets despite knowing that all three of these behaviors are ill‐advised from a public health perspective. Denial is easy as long as it works in a person's favor and thus (in this example) lets a person continue the risk behaviors of smoking, eating a diet that causes obesity, and consuming highly processed foods loaded with sodium. It has also been my constant experience that this denial may persist even after, for instance, a mild heart attack occurs. With COVID‐19 as the example, denial relative to the value of the vaccine did sometimes (but not always) wane after unvaccinated people were hospitalized with COVID‐19 or a family member died of the virus. This is a relatively dim portrait of Americans; however, it played out over and over again as the U.S. epidemic marched onward.
As the global pandemic played out, I was in the process of writing this textbook. I had promised myself I would write this chapter last, hoping that by then at least the U.S. epidemic would be mostly resolved. It did not happen that way: the American epidemic and the global pandemic were constantly “events in motion,” as evidenced by emerging variants and the unspoken but always present fear among experts in infectious disease that a variant might come along and evade any immunity provided by the vaccines created in 2021. This very real prospect was terrifying to the point that it was difficult to even imagine the public health consequences. I soon resolved that this chapter would never be finished in terms of summarizing the start and finish of COVID‐19. Instead, it became clear to me that all this chapter can do is convey to you a sense of what life was like – from a public health perspective – during what I will refer to as the “early years of COVID‐19.”
The early years were punctuated by a lack of understanding of the basic disease transmission routes of COVID‐19 and the contents of the vaccine against moderate to severe illness (the vaccine was never meant to be one that averted illness entirely). However, this lack of understanding was no surprise, as it had existed in the past for diseases such as influenza. The problem was that the public soon grew weary with the task of learning about COVID‐19 and thus gravitated toward creating “local truths” via friendship groups and social media. Masks worn based on mandates were often worn below the nose. Makeshift masks – such as bandanas – were used, despite their complete lack of protective value. Business establishments paid more attention to sanitizing surfaces than enforcing the correct and consistent use of properly fitting and highly protective masks. Even worse, anti‐vaccine groups used Facebook, Instagram, Twitter, and other popular forms of social media to finally have their time in the spotlight, sowing doubt about the billions of dollars' worth of carefully conducted research and development that had successfully led to a vaccine in a historically rapid time after the virus was discovered. Our public health system was not robust enough to avoid this near‐constant level of information decay.
But information decay was only one problem. The other was that people were used to books, movies, and so on portraying disease outbreaks as time‐limited. Business and industry leaders were particularly quick to impose a time frame on the virus and predict dates when life (and work) would “return to normal.” Simply stated, none of this rises above the level of wishful thinking. History shows that viral pandemics can last for decades or even centuries. The virus has become part of modern life, and it will run through the human race on a schedule largely determined by its random mutations. As a teacher, I make it a habit to use metaphors when explaining complex phenomena. In that spirit, let me suggest that the public response to the COVID‐19 epidemic in the United States was much like people being trapped at the exit of a grocery store by the rapid onset of heavy rain with no end in sight. At first, people gathered by the door, saying, “It won't last long.” As time crawled by, some people said “F‐‐‐ this; I'm going out.” As the rain began to subside, others said things like “It's good enough now – I'm out of here.” Eventually, others were forced to leave due to obligations beyond their control – they had to leave despite the continuous downpour. Roughly speaking, the vast majority of Americans soon chose to “brave the rain” because they were exhausted from social isolation or decided that this was the new normal. Millions of others fell in the metaphoric category of being “forced to leave due to obligations”: their work and/or family life (particularly when schools reopened) allowed no choice except a return to places of employment such as restaurants and bars, where mask wearing was not practical or practiced.
Ultimately, as the third year of the pandemic began, I was humbled about having spent my career as a professor of public health. That title had seemed somehow noble to me, as though we were protecting the public from harm. The reality was that public health was an untested entity in the 21st century, at least until COVID‐19 appeared and showed that the public health system was not yet ready for such challenges. There is indeed much to be done, and much of it has to be done differently to be effective in the presence of the next pandemic!
As the Delta variant quickly dominated the U.S. COVID‐19 epidemic, virologists and other scientists feared this could be the new normal. Even prior to Delta, this fear was apparent in the writings of experts; it finally also penetrated the psyche of most Americans. For the first time in their lives, millions of Americans began to realize that something as tiny as a virus could bring industry, business, and the global economy to a near standstill. In the middle of the 2021 holiday season, the WHO warned the world about the even greater dangers of the Omicron variant. By this time, it was clear that humans would have to adapt or face an ever‐increasing escalation of daily death tolls.
In early October 2021, the U.S. death toll from COVID‐19 surpassed the 700,000 mark. The worldwide myth – emanating from developed nations such as the United States – that any infectious disease could be controlled had been completely shattered by COVID‐19. The failed public health system was magnified by Centers for Disease Control (CDC) Director Robert Redfield, who played down the severity of the virus and often altered the findings and conclusions of scientists to create a much less harmful public image of the potential for COVID‐19 to destroy lives and greatly diminish the quality of Americans' daily existence.
In contrast to the United States, other developed nations were far more proactive. For example, on December 19, 2020, Britain Prime Minister Boris Johnson delivered a national broadcast to citizens that was essentially a message to please stay home for the holidays and that – despite efforts to the contrary – he was forced to “cancel Christmas.” His message was one of protecting Britain from a new and more contagious strain of the novel coronavirus by instructing Brits via a set of nationally established rules pertaining to closures, prohibitions on travel, rules against inter‐mingling between households, and the use of safety precautions such as masks and social distancing. His tone and words conveyed a strong sense of urgency, tempered by clarity and confidence. It was an inspirational moment in British history. Unfortunately, a counterpart moment never occurred in the United States. Instead, the U.S. president (Trump) took a nearly opposite approach to the pandemic, engaging the nation in a series of tweets, press statements, and speeches that dismissed the problem as largely inconsequential. As case numbers climbed throughout the spring of 2020 and the death tolls crept into the six‐figure range, the White House and the president continued to dismiss the advice of infectious disease experts and appointed largely unqualified people to lead U.S. efforts to curb the spread of the disease. As 2020 was an election year for this president, it was clear that suppressing the severity of the U.S. COVID‐19 morbidity and mortality figures was an important priority. The CDC director (Redfield) subsequently admitted to softening the previously drafted directive language used by the CDC to provide guidelines designed to control the spread of the virus in high‐risk settings such as meatpacking plants and schools.
As it turned out, the U.S. COVID‐19 epidemic was the first time in American history when the disease became a political dividing line between Republicans and Democrats. Even after 2 years of claiming lives and destroying local economies, people took preventive action largely predicted by party affiliation. For instance, Democrats were generally about twice as likely to be fully vaccinated as their Republican counterparts. Even entire states such as Florida and Texas fought mask‐wearing mandates, with Florida going so far as to pass legislation against such mandates. Having put mandates into place regarding mask wearing, Governor Gretchen Whitmer of Michigan subsequently became a target of hostile people strongly opposed to this well‐established protective action. The hostility elevated to the level of death threats and intruders on her home property. This type of division in the nation set COVID‐19 apart from any other national epidemic in U.S. history.
At a time when the people needed most to be united, they were more divided than ever before. Most tragic in this lack of unity was that COVID‐19 had disproportionately infected (and killed) people of color – a point that was consistently made by Democrats and seemingly ignored by Republicans. The United States is home to what has consistently been a glaring cascade of health disparities that are not unique to COVID‐19 and that all favor white, non‐Hispanics over people of color (as you progress through this book, you will learn just how insipid and devastating these racial/ethnic disparities are in terms of health and disease).
Just prior to Thanksgiving 2021, the Johns Hopkins system of tracking COVID‐19 deaths was used to report that the death toll could be compared to entire states! Using this data, the Washington Post reported, “If the Americans who've died of Covid made up a state, it would rank 47th in the country, more populous than Alaska, Vermont, or Wyoming” (Fisher, Royza, & Ruble, 2021).
