Contagion - Blog Assignment 5

The movie, Contagion, directed by Steven Soderbergh, follows the spread of a new and fatal virus throughout the world as the CDC, government, and Public Health officials scramble to control and stop it. While the virus began by only first infecting a few, the slow response from the Public Health system combined with the mutating and contact-spread nature of the virus, millions were infected throughout the world. As more and more people died, with as many as 1 in 12 people around the world being infected, those involved in disease control worked to understand the disease, prevent panic, create a vaccine, and distribute it to the masses to stop the virus in its tracks.

            This was my first time watching Contagion, and I found myself recognizing many things throughout the movie that I’ve seen in the Public Health course. From epidemiologists being called in to investigate the virus to Public Health officials determining the best ways to prevent the spread of the disease without causing panic in the public, this movie put into action many of the Public Health concepts we’ve been learning and reading about. Thus, not only was the movie entertaining and fun to watch, but it really made these concepts come to life and allowed me to see them in action.

The outbreak of the virus, which is defined as the abrupt increase in the number of cases, in Contagion occurred when the virus first began infecting and killing people, since this was a disease not yet seen before. Once the virus had its outbreak, an outbreak investigation took place. In this investigation, a number of steps were taken from mapping the spread of the outbreak to developing hypotheses as to how the disease spreads and how to protect against it. Specifically, the public health and CDC officials in Contagion conducted their investigation and figured out that the disease spreads through contact, with an initial reproduction number of 2, which grew to 4, collected data of infected and death rates, and developed ways to slow down spread, eventually creating and distributing the vaccine to prevent it. However, before the vaccine was created, the Public Health and CDC officials put into place practices of isolation and quarantine to protect those who still hadn’t been infected. Isolation occurs when the sick and infected are separated from the healthy to prevent exposing them. In Contagion, the sick were isolated into hospitals and into large facilities. Additionally, those who were only exposed to the virus, but still had not shown symptoms, were quarantined, which means to restrict their movement and thus the spread of the disease, as to additionally help to prevent the virus from spreading.

One of the areas in which the public health agencies could have been better prepared in Contagion was in the hospital facilities and staffing. Early in the outbreak of the disease, hospitals became filled up and the infected had to be crammed together in last minute pulled together facilities. The infected quickly exposed both other patients in the hospitals as well as nurses and doctors because enough facilities were not available to isolate the victims initially. Because of this, the infected exposed those who were trained to help the sick, just making the problem worse. Eventually, those helping the sick were prepared with full body suits and those infected with this particular virus were isolated, but this should have been done much sooner. This did not happen because these hospitals were not prepared, both facility wise and staffing wise, to contain the sick and prevent them from infecting those within the hospital system.

Additionally, problems arose during food distribution, which exposed a lack of preparedness in this area as well. Although there was some prepackaged food available for people to obtain during the process of vaccinations, this supply was limited and poorly organized. Because of this, not everyone received it, causing panic, and leading to violence in order to get a hold of the few resources available. Thus, public health agencies were not prepared in both number of supplies as well as in controlling the distribution. Being better prepared would have involved having a much larger supplies of food available and creating a better organized system so that the distribution could have been monitored and better controlled as to prevent stealing from others. 

U.S. Health Care: The Good News

            In the PBS Video, entitled U.S. Health Care: The Good News, the possibilities of improving the Health Care system are presented through looking at the communities who have high coverage but low spending systems.

At Dartmouth College, Medicare billing records were studied by economists and published in “The Dartmouth Atlas of Health Care,” which has become the go to text for healthcare variation. They found that there is huge variation in treatment and spending on Health Care in communities across the country. They also found that the more doctors in a community, the more doctor visits, and the more scanners, the more scanning images. This often results in excess care, and is not necessary, but is still being paid for. In a system where supply drives demand, we aren’t getting the value we need from healthcare.

Healthcare is something that is needed throughout the life of an individual, and even before they are born. Thus, I feel that Health Care should be a right for all Americans. I do not believe that low-income families should suffer by not receiving health insurance simply because they can’t afford it. Not giving them health care would ultimately result in more hospital visits, which costs the system more than if they were given treatment. Thus, not only should health care be a right because the government needs to provide a way to keep every American healthy, but this is ultimately going to save money for the health care system overall.

In communities across the country, innovations in Health Care have been adopted that have shown improvement in patient care and lower spending. In Grand Junction, Colorado particularly, I found their innovations to their healthcare system to be extremely important. In pooling the fees for all procedures, and in coming up with set fees for each procedure for all payers, any person with any type of Medicare can receive the treatment they need and physicians get paid the same amount for any type of patient. This allowed Grand Junction to have a very efficient, low cost, and widely distributed healthcare system. Additionally, they made a commitment to providing care for all pregnant women, which ends up saving them money overall because less problems for the infants result later on. In Seattle, a large practice of 900 doctors, called GroupHealth, the “patient centered medical home” has been put in place. The whole medical team is responsible for every patient and revolves around the patient schedule, which are both better for the patient and the doctor. Additionally, all records are electronic, improving care and saving money. At GroupHealth, part of the physician’s job is to answer e-mails, which leaves time to take care of every issue the patient has. In Everett, Washington, the Everett Clinic is a model for high quality care at reasonable cost. An innovation they’ve put in place is the elimination of unneeded and costly tests. If an ailment does not meet certain criteria, the patient will not get that test, which saves money. In Providence, the poor are better taken care of by using resources as efficiently as possible. They use transfusions as a last resort, and since the cost of blood is so high, the system saves money by not providing unnecessary blood transfusions. In the Dartmouth Hitchcock Medical Center, they get the patient involved in making treatment choices, called “shared decision making.” 

I think that an aspect of Grand Junction’s healthcare system that can be applied in my home city, Detroit, could be the charity clinics. This is an aspect of their healthcare system that wouldn’t take money away from the physicians, which might be a harder thing to make happen, but would help the public and help save the city money. In charity clinics, private insurers and donations of hospitals help to pay for the uninsured, which ultimately saves the system money because healthy people cost less. Additionally, records could be entirely transitioned to an electronic system in order to save money and to create a more efficient system. Lastly, a criteria for various procedures could be created so that less unnecessary scans and procedures are done. These may not have been put into place because physicians and the hospital would have to put patient care and the importance of patient cost above the money they make, and could potentially make less money themselves with a more efficient system, which is difficult to get a consensus on. 

The Vaccine War - Blog Assignment 3

The Vaccine War is a video that portrays the two opposing sides in the debate over immunization. The views of parents who believe that vaccines are unnecessary and have side effects that are far too risky are contrasted against the views of doctors and researchers who explain why vaccines are extremely crucial in keeping the public safe from disease.

1.     Watching this video definitely changed the way I think about vaccinations. Growing up with a physician as a mother, I’ve never questioned or even second guessed getting a vaccine, and always saw them as something extremely important and crucial to have. While I knew there were stories out there about people falsely believing that vaccines could result in terrible side effects, such as autism, I had no idea there was such a large fraction of the population that refused to get vaccinated. Also, I was not aware that this there were enough people that made the choice not to get immunized that public health officials and physicians are worried that diseases that are currently not seen in the US could possibly come back as a result. I thought this video illustrated the points of view of both sides very well, and it allowed me to understand why someone would choose to refuse a vaccination, which beforehand I did not know.

2.     According to the video, herd immunity refers to the immunity that happens when a certain number of the population is vaccinated to the point where a virus will be stopped from spreading. With this type of immunity, you are benefited by the vaccinations of others. Some diseases could be completely eradicated with a strong herd community, rendering the vaccine unnecessary. However, if a critical number of people are not vaccinated, those who don’t get immunized or those that can’t be immunized are at risk for disease. When enough people aren’t vaccinated, herd immunity suffers, and the disease can begin attacking the venerable.

3.     Vaccination differs from other type of person health decisions because it something that can have drastic effects on the entire population. Choosing not to vaccinate not only puts yourself at risk of disease, but also threatens the entire unvaccinated population to the point where an eradicated disease could be brought back. While I personally believe that parents should consent 100% of the time to getting their children the necessary vaccines, it is mostly the decision of the parents. The pediatrician should also have a say in the vaccination process, and should work to thoroughly explain the benefits of vaccines in order to get as many parents as possible to agree.  Lastly, I think that public health officials and the government should make sure that all schools, not just public schools, require necessary vaccinations, since schools are the breading grounds for the spreading of disease.

4.     One of the reasons children might not receive their recommended immunizations is that their parents refuse to get them done. Parents who believe these vaccines put their children at risk, that they go against their religious beliefs, or simply feel they are unnecessary can choose to allow their children to grow up without getting immunized. For pediatricians in family practice, financial costs could be a reason vaccines aren’t administered if they are running their own business. Additionally, the healthcare system could not cover the cost of vaccines making some family unable to get them.

5.     One of the main reasons patients are against vaccines is that they believe the diseases vaccines protect against only occur in the developing world, and that because of this, the potential side effects of vaccines are not worth being put at risk for. Thus, it is not only necessary for information about the limited risk of side effects to be projected to the public, but also to inform the public that these diseases can and will come back if too many people do not get immunized against them. The way that the most amount of people can be efficiently informed of what vaccines help protect us against are in commercials, such as that for the whooping cough which is run daily. I feel that a commercial campaign would be the way to cause the greatest improvement in this vaccination issue. By illustrating the detrimental effects of the diseases vaccines prevent against, people would be more willing to get the immunizations than they would if they had only heard the disease and knew that it no longer existed in the US. 

Secondhand Smoke Causing Lung Cancer - Blog Assignment 2

1.     The study was conducted by following the rate of mortality due to lung cancer in 91,540 Japanese women above 40, who did not smoke themselves, but had heavily smoking husbands. The study analyzed data from 29 health center districts in Japan during a span of 14 years, from 1966 – 1979. In order to gather data, almost the entire census population was interviewed. The population’s risk-factor records, residence lists, and death certificates were followed as well. The main result of the study was that the wives of heavy smokers displayed a much higher rate of mortality from lung cancer. Lung cancer rates also showed a correlation with both age and the husband’s line of work, with the highest risk being associated with agriculture with husbands of age 40-59. Additionally, the greater the dose of cigarettes smoked daily by the husbands, the greater amount of lung cancer seen in their non-smoking wives. Although smoking does affect the lung cancer prevalence in their wives, it appeared as though no other types of cancer were brought on by this exposure to passive smoke.

2.     I think that it is extremely important to notice that it is not only those who are directly taking part in cigarette smoking that are suffering from disease and mortality as a result. Just being around a smoker, as in the case of non-smoking wives of heavy smokers, has resulted in a greatly increased risk of dying from lung cancer. Thus, cigarette smoking has far greater and more detrimental consequences than to just the direct partaker. Anyone who is even in a close distance of a smoker on a regular basis can develop fatal cancers, which could mean that one person’s decision could affect his or her entire family. Additionally, I found it interesting that the wives of husbands who were involved in agriculture were most affected. I would think that those in more city areas, where people are more congested and there is more smoke to be subject to, rather than rural areas where there are less people and more open spaces, would cause the wives to be more heavily affected. But, as raised by the study itself as a possible reason, couples may spend more time together in a rural area and thus could be around the smoking more, which I would have never thought of.

3.     There are a few advantages of using this type of study design. Firstly, the data analyzed in this study was collected using government-based records. By using actual records, such as death certificates, rather than phone surveys for example, the numbers are very accurate, since people cannot possibly lie or alter the data. Additionally, the study collected data for 91-99% of the census population, which is a huge amount of data points. With this amount of data collected, and with it being from the majority of the population in a wide area, the study is much more accurate.

4.     I believe that the results of this study support secondhand smoke as a cause of long cancer. The results are accurate because the study was conducted using a very large sample, with 91-99% of the census population of Japan being included. Thus, the results are very representative of the general population and precise as well. In addition, the data displayed a correlation between exposure and disease, with the wives exposed to passive smoking as having a much higher chance of developing lung cancer over wives who were not exposed. Also, as the amount of exposure increased, as in the dose of cigarettes the husbands smoke daily, the likelihood of getting lung cancer increased as well. With all these correlations in place, it is very clear that passive smoking surely increases the rate mortality due to lung cancer.

Binge Drinking - Assignment 1

1. In 2011, Centers for Disease Control and Prevention posted a report on binge drinking in women. The information this report was based on was gathered from the 2011 Behavioral Risk Factor Surveillance System and from the 2011 national Youth Risk Behavior Survey. The study found that binge drinking is a major problem amongst young women, with tens of thousands of deaths and hundreds of thousands of years lost because of it. Binge drinking was found to be highly prevalent in females, and done so frequently and intensely by most. The report found that the highest amount of binge drinkers occurs among women between the ages of 18 – 34. This group of women also showed the most frequent and intense involvement in binge drinking compared to High School girls and women ages 25-34. Another major finding of the study was that there was a correlation between household income and the amount of binge drinkers, as the amount of binge drinkers increased with increased income. Additionally, it was determined that binge drinking is very common amongst High School girls, with the majority of girls this age who drink alcohol in general, also participating in binge drinking.

2. Binge drinking amongst women requires attention as an important public health issue because there are major risk factors that are involved with this kind of activity. The health of women who participate in binge drinking and do so frequently is in far more danger than it would be if they didn’t partake. With potentially life shortening and, in some cases, fatal consequences, this is an issue that needs to be assessed, addressed, and hopefully improved. Binge drinking in women, specifically, is a pressing issue because of the generally larger and more negative effects alcohol has on them versus men due to body makeup. Additionally, the possibility of pregnancy makes this activity in women more urgent.

3. As a girl within the age group being studied, I find these results to be relatively representative of what I’ve observed in my own experiences. Especially as a college student, I see binge drinking very prevalent here on campus, as well as when I was in high school. Thus, the high frequency and intensity of binge drinking seems accurate.

There would definitely be some issues with the accuracy of the self-reported data in this survey. For some, they recognize that binge drinking is looked down upon and might understate how much they drink. It is possible that there is a larger prevalence than reported due to the women being surveyed altering their answers.

4. For girls and women at this age, it is rare that the potential risks and consequences of actions involving alcohol are brought into mind. Thus, in order to make an impact and change the amount of binge drinking that occurs, it is definitely important to make these girls and women see the potential harms in their actions. A widespread campaign that shows women who are suffering from their actions with binge drinking might influence a good amount of women to at least lower their intake. To 9im9help the situation further, the laws that make alcohol more difficult to get could be more enforced. Especially in places where there are large amount of young women, such as in college towns or near universities, it could help to crack down more on underage drinking so that at least binge drinking in women under 21 could be reduced.