Medicine's Intelligent Brother

Public health is medicine’s introverted twin brother.  By nature, it remains unseen, flying under the radar to vigilantly maintain and raise our standards of living.  It does this all without our knowledge, for when we don’t see it, it is working most efficiently.  Public health is truly the unsung hero of the 20th century, singlehandedly saving countless of lives by sanitizing our water, vaccinating our children, and improving our health.  Here are a list of its greatest achievements of the last century, compliments of the CDC.  This list was included in the article, “Ten Great Public Health Achievements--United States, 1900 to 1999.” Count how many you take for granted: 

o    Vaccination

o    Motor-vehicle safety

o    Safer workplaces

o    Control of infectious diseases 

o    Decline in deaths from coronary heart disease and stroke

o    Safer and healthier foods

o    Healthier mothers and babies

o    Family planning

o    Fluoridation of drinking water 

o    Recognition of tobacco use as a health hazard

I know how many I take for granted: all ten.  However, some accomplishments are easier to ignore than others.  For instance, safer foods and healthier mothers and babies.  


While eating, we rarely stop to contemplate the safety of what we are ingesting. Eating is such a routine part of our schedule that it never receives much thought until it gives us problems.  I recall one interesting fact that our professor, Dr. Alexander, shared with us: people who are ill are better able to remember what they recently ate than people who are healthy.  This is because food has suddenly become more important to them, as it could be the reason behind their illness. 


Food safety began receiving attention with the publication of Upton Sinclair’s The Jungle, which revealed the unsanitary conditions of the meat packing industry.  His book lead to public outcry and subsequential public health initiatives. We owe Sinclair many thanks for this.  Without him, we would still be eating sausage imbedded with rat droppings and salmonella among other surprises for breakfast. 


As a woman, maternal and neonatal health hold particular importance to me.  I am grateful for the tremendous initiatives taken to improve maternal health over the 20th century--mortality rates of pregnant women has decreased by 99% and infant mortality by 90% in the US.  Even still, half a million women die every year as a result of complications related to pregnancy and birthing.  Although I see maternal health and food safety to be of particular importance, I recognize a myriad of other health concerns waiting to be praised.


The CDC may provide us with a comprehensive list, but it is in no way complete.  Acknowledging all of the public health accomplishments is a difficult task because we take most of them for granted. Simpler initiatives, such as iodizing salt, deserve more recognition.  Because we have iodized salt in the US, we have improved our metabolism, strengthened our bodies, and even raised our IQ levels by 10 points each!  


Number 11 on the CDC list should be environmental improvements. On the global scale, environmentalism has become a facet of the public health initiative.  By seeking greener models for sustainable development, we have inadvertently created a more livable society that keep us healthy. Environmental change and health are undeniably connected and an integral aspect to the ever-increasing successes of public health. Indeed, public health is also medicine’s more intelligent brother. 

America's Preventable Epidemic

Contrary to most developing nations, America has public health problems of opulence; we can afford to eat richer foods, and more of them.  This not only affords us a comfortable lifestyle, but also the highest rate of childhood obesity.  For the past few decades, this rate has continued to increase at an alarming rate -- the number has tripled since the 1980s!  WHO has some interesting, and alarming, statistics.  The rate of obesity is increasing in both boys (up from 5% to 13%) and girls (up from 5% to 9%). 22 million in the world under 5 are overweight.  Of those, the majority are American.  

Obesity brings many related health problems, both physical and mental, including type II diabetes, high blood pressure and cholesterol, poor self esteem and even depression.  Public health can prevent obesity before these related medical issues need to be addressed.  In fact, public health initiatives will be the only effective form of intervention because obesity is a public health issue; it results from the unhealthy habits of a population as a whole.  But, the difficulty is figuring out the most effective solution to address the problem.  

A recent study, published in the New York Times, researched a solution to curtail this huge problem.  The idea was simple, yet ingenious: “school based health intervention” they call it.  The interventions teach kids healthy habits, increase their physical activity, and improve lunch options in the cafeteria.  This gives kids not only awareness, but also access, to healthy eating. 

To test the effectiveness of these interventions, a cohort study was used to follow over 4,500 students, split equally into two groups: one participating in a school health program, the other acting as a control.  The students were followed for the duration of middle school.  By eight grade, the rate of obesity declined significantly in the children participating in the health program -- by a full 24.6 percent.  But, surprisingly, the control group dropped by even more -- 26.6 percent.  So, what exactly does this suggest?  

The researches believe this indicates a much larger trend--a nationwide decrease in childhood obesity.  They see outside factors as contributing to the decrease in obesity rates of the control group as well as the experimental group.  However, I remain a little skeptical of this conclusion.  Unable to pinpoint exactly what these outside factors may be, the researchers seem uncertain.  Furthermore, the results do not seem to correlate.  Why would the control group have a higher decrease in obesity than the group with the health interventions?  If the same outside factors were influencing both groups, the experimental group should still have a larger percentage decrease because they also received further health interventions.  

The inconsistent results could also mean that the intervention was ineffective and obesity decreased due solely to other factors.  Or, it may indicate some selection bias within the study.  (i.e. could more children in the control group come from wealthier families, who can afford healthier, organic foods?)  Either way, potential biases of the study could possibly undermine its validity.  By controlling for these factors, the study could be strengthened.   

Despite these apparent weaknesses, I still find the school based health intervention approach to be innovative.  I think that, with further studies, this sort of approach will be confirmed as helpful.  If implemented in all public schools, I see it as having great potential to halt the nation’s most serious, yet preventable, epidemic: obesity. 

Closing the Gap

Welcome!  This blog will cover my intellectual journey through the many layers of public health.  My name is Anna Wherry, and this journey begins as a freshman at Johns Hopkins University.

As a college student, I am frequently asked the classic question, “What’s your major?”  Whether asked by an adult or a fellow student, the reaction to my response is usually the same: How did you become interested? What exactly is public health? 

The answers to these questions are not so simple.  

Public health first captured my interest here in Baltimore.  It was the summer between my sophomore and junior year in high school.  Insisting I not waste the summer in our comfortable suburban neighborhood, my mom dragged me to the uncomfortable world of East Baltimore.  

My task was daunting: to survey refugee patients at a local community health center.  Concerned about cultural and language barriers, I approached the opportunity apprehensively.  

But, I was also excited.  I thought people who had experienced health care in developing counties could provide me with a window for evaluating health care in this country.  During the surveys, it was startling to hear that some refugees thought they received the same or better quality health care in their home country. The basis of this perception may lie with their definition of quality health care. To them, quality was a matter of simplicity, accessibility, and affordability.  Once in the United States, refugees face the same healthcare barriers as we do.

Talking with refugees also gave me insight into their cultural views of healthcare.  These views had an obvious influence over their perception of westernized health and made me realize the importance of cultural dialogue in healthcare.  

At the time, I couldn’t come up with a logical explanation for these findings from the survey on my own, but realized I could come to understand them through studying public health.  

I am just beginning to fully grasp its complex layers -- which include public policy, medicine, environment, and philanthropy -- through my Intro to Public Health class.  I am learning that public health is a broad term.  This term isn’t always understood by communities, yet these people are exactly who public health effects.  

It is a discipline dedicated to the health of the public as a whole.  This is how public health differs from traditional medicine.  Doctors treat individual patients.  Public health officials strive to improve living qualities and the health of an entire population.  They focus on preventive measures, including health education, policy initiatives, sanitation, and structural and environmental changes.  

Because preventive measures usually aren’t enough (people are bound to get sick), public health officials also work to increase access to medical care.  For people like the refugee patients, this means all the difference.  They defined quality care to me using terms such as “easy” and “cheap”; their concerns were accessibility and affordability rather than quality.  Public health addresses these concerns to make sure that even newly arrived refugees have access to quality care. 

From discussions with refugees to lectures in class, I have come to realize the cause that I am dedicating my life to: closing the gap! 

Anna