My first full-time professional job as a registered nurse was as a public health nurse with the Seattle-King County Health Department. I spent a quarter as a student public health nurse and knew I had found my chosen career. What better place to prevent and heal than in people’s homes, the place most familiar to them.
I held my breath when I had my last conference with my public health instructor. I was sure that the pressure of family issues unknown to her had influenced my grade and chance for the job. I burst into tears when she told me I aced it and would recommend me. She never let on if that explosion of relief gave her second thoughts.
In those days, public health and visiting nursing were combined. I saw moms with new babies and people too ill to see their doctor. I will never forget teaching a 90-plus-year-old-man to give morphine injections to control his wife’s pain as she lay in their bed dying. I was greeted once by an old woman with wild red hair growing out gray carrying a rifle. I testified at a hearing about a young woman’s abuse of her new baby who seemed to believe a baby had the volition to cry just to irritate her.
Part of our public health role was to give immunizations, teach about the transmission of disease and infection control and teach pregnant women about their bodies, babies and pregnancy in preparation for childbirth.
The dominant mission of public health was then and is now prevention. Public health then and now covers most phases and aspects of life, although with significantly less resources now. Key to the fulfillment of the mission is epidemiology, the scientific study of the incidence, distribution and control of diseases and other factors related to health.
Once known, once understood we can begin to put in place measures of prevention. That is public health.
Public health is prevention
Public health professionals talk in terms of levels of prevention, the first being primary meaning prevent the disease or condition from happening in the first place. Next comes secondary or treating it early and stopping the worsening of the condition and/or the spread to others once it starts; then tertiary or preventing complications by management of the disease.
Think about diabetes as an example. Primary prevention involves managing diet, weight and activity so the body won’t develop diabetes. Secondary prevention involves discovering the disease early and instituting measures that can control the disease such as losing and maintaining a healthy weight through diet and exercise. Tertiary prevention begins at the point the disease becomes chronic when the effects of diabetes are in place; care becomes focused on preventing the worst effects such as blindness and amputations.
Diabetes is just one disease among hundreds of thousands that demand study so we will know, will understand and will be prepared in all the levels of prevention.
Right now, we are faced with the coronavirus that is making its way into a worldwide epidemic. We observe those levels of prevention functioning as first cases are isolated, then more testing is put in place to discover infections and those who are seriously compromised are put in isolation in a hospital.
I heard a public health expert, a medical doctor with a master’s degree in public health, say that viruses such as the SARS and Ebola viruses show up as new viruses for which little information is available and are therefore unpredictable in spread, strength and degree of illness. He made the point there is always some confusion of activity at the onset.
Public’s health requires response system
A public health system needs to be in place to respond to potential epidemics and pandemics much like a military response system needs to be in place in the event of an invasion. A good system mobilizes experts who readily direct activities and deploys resources at all levels required to contain and control outbreaks. It’s the public health version of military readiness.
Think back to the Ebola crisis and the initial fears due to the virus’ highly contagious nature and known ravages of the virus on the body. It took a bit of time to determine the characteristics of the spread and the level of prevention needed, but eventually the disease was brought under control.
People in the Obama administration at the time reasoned that if an alert and mobilization system was in place earlier, resources would be available sooner and lives would be saved. People present at the time saw virus epidemics as a threat to national security.
President Obama established a team of experts to respond to epidemics and pandemics referred to as the global health security team as part of the National Security Council (NSC). We see now that possible pandemics impact national security in many ways, including our economy. People are staying in, businesses are cutting back and the stock market is falling.
We all know that Trump administration did not agree with the level of importance placed on rapid response and eliminated the global health security team in 2018. John Bolton, the then NSC director and soon-to-be wealthy author of a book on his experiences, was the lead decision-maker.
Not unrelated, at least to me, is Bolton’s elimination of the cybersecurity coordinator position on the council, also created by Obama to bring the national security threats issues closer to the president.
I surmise the thinking in establishing the cybersecurity position was to avoid crisis response being stuck in bureaucracies. I surmise that part of the decision to eliminate these functions at the level of the president was that it was Obama’s and our president has vowed to rid a government of anything with Obama’s name on it. It seems to me that most of the elimination is based on a poor understanding of the risks associated with pandemics and the government’s role on the part of the president and those that surround him.
Part of the ignorance is caused by the president and his administration’s failure to listen to the scientists, the epidemiologists — the experts in most fields. Climate change is the poster failure to prevent a crisis when proclaimed a “hoax.”
Our president seems to have little trust in facts especially when facts don’t fit the political rhetoric of the Republican party or his attempts to blame the Democrats. Coronavirus is not susceptible to politicization in that it’s very hard to blame someone and not appear silly.
We need to insist that our elected leaders — federal, state, local — recognize the importance of prevention at all its levels and stop playing politics with our national and community security and start paying attention to threats whether pandemics, darkened cyberspace, tornadoes that kill 22 people in minutes or missiles from North Korea.
Bertha Cooper, featured columnist in the Sequim Gazette, spent her career years in health care administration, program development and consultation. Cooper’s book “Women, We’re Only Old Once” is due out this summer. Cooper and her husband have lived in Sequim over 20 years. Reach her at firstname.lastname@example.org.