Tuesday, Aug. 12, 2003 | 8:39 a.m.
Editor's note: In August the Where I Stand column is written by guest writers. Today's columnist, Dr. Donald S. Kwalick, is chief health officer of the Clark County Health District.
TURBULENT world events, the threat of bioterrorism and emerging diseases have created a heightened interest in the role of public health. This attention comes at a time when local authorities are struggling with budget deficits while at the same time receiving money earmarked to create and strengthen programs dealing with terrorism.
The threat of terrorism is real and we must be prepared to deal with events that were once unimaginable. However, we are also facing very real threats from naturally occurring illnesses, such as severe acute respiratory syndrome (SARS) -- the effects of which could be just as devastating as a deliberate attack with a bioterrorist weapon. Our community and our country were fortunate that domestically the SARS outbreak stayed relatively confined and did not widely affect our health or economy as in other areas.
Nonetheless, we are affected by disease and public health threats every day. Recently a case of infectious tuberculosis was identified in an inmate of a correctional facility. Our case investigation revealed this person had been in a municipal court several times over a period of months. Hundreds of contacts were identified and tested for exposure to the illness, all at health district cost.
Despite the cost to the health district, this is money well spent because with many communicable diseases we are faced with a "pay now or pay more later" situation. To not pursue contacts of persons with infectious tuberculosis aggressively could lead to an outbreak -- and tuberculosis treatment can be prolonged and expensive. If a person develops tuberculosis that is resistant to treatment, the cure can cost upward of $200,000.
Tuberculosis provides a prime example of what happens when we become complacent about public health issues. The disease was once the leading cause of death in the United States. Improved medical treatment and new therapies led to the steady decline of the illness, making the elimination of tuberculosis in our country an attainable goal. In the mid-1970s, when tuberculosis seemed well under control, funds, once designated to the prevention and control of the disease, were directed towards other areas. The upshot of this loss of funding and attention led to reversal of the trend toward elimination and case increases of 20 percent between 1985 and 1992.
Funding to deal with the threat of terrorism is vital, but as the tuberculosis example illustrates, it cannot be at the expense of ongoing public health programs. These programs, while more familiar, still have the potential to significantly impact our health and cannot be neglected.
Overall, the influx of bioterrorism funding has benefited our public health infrastructure. We have strengthened surveillance, planning, and training programs and will soon operate a local public health laboratory. The laboratory and our enhanced surveillance capacity aid in our ability to identify disease outbreaks and unusual occurrences of illness -- two important functions that boost our preparedness and response efforts for both a natural or deliberate outbreak.
However, in some instances the funding comes with stipulations that -- while important -- tax our already limited resources. Health district staff spent countless hours meeting the requirement to have a Smallpox Response Plan in place. This was a beneficial exercise, and the finished product can be applied to other communicable disease response scenarios. However, at the same time we were completing this plan we were facing funding cuts from the state and operating with the tightest budget in our history. Our strained budget prompted -- among other cost-saving measures -- a hiring freeze which resulted in one-sixth of our staff positions remaining unfilled for the bulk of the fiscal year.
Despite these challenges several accomplishments are noteworthy: New cases of tuberculosis have decreased over the past three years from more than 100 to 70 cases per year; implementation of the hepatitis A vaccine requirement resulted in cases decreasing from over 200 in 1998 to 26 in 2002; the more than 50,000 inspections of food establishments, swimming pools and other public facilities conducted each year ensure regulatory compliance and prevent illness; and the more than 500,000 clinical services offered annually in such programs as family planning, child and adult immunizations, well-baby check-ups, nutrition and home care provide for healthier lifestyles and minimize communicable disease outbreaks.
For many years public health agencies have played an essential, yet largely unnoticed role in the community. It is important that when the spotlight fades the attention to public health activities not diminish. Restoring, maintaining and supplementing support for public health programs is imperative if we are to keep up with our massive growth and the evolving health needs of our community.
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