July 31, 2013
Who decides what health services are needed and which are unnecessary? Public health officials investigate the needs of a population in order to bridge health inequities. But there are multiple kinds of needs. During Dr. Anees Pari’s lecture on public health, I realized that performing a Health Needs Assessment on a population is quite a complex matter.
When you go to your doctor with a problem, you may find that what you’re expecting and what your doctor recommends are different. You may want to take drugs to quickly fix what is wrong, while your physician may recommend lifestyle changes to make a longer lasting health improvement. These represent different needs. Felt need is what you feel like you need, while normative need is what professionals would recommend. Public health officials have a job that tries to match up needs, demand, and supply. Locally, nationally, and globally, this can be a difficult issue to tackle.
In current times, developed countries often give aid to developing countries. For example, outsiders would bring in polio vaccines to Nigeria. Polio is a viral, infectious disease that is nearly eradicated. However, a stigma about the vaccines arose, with leaders claiming that the vaccines actually served to sterilize Nigerian Muslims. In this case, the supply and normative need are present, but the people of Nigeria rejected it. As a result, people end up infected with a disease that most of the world does not have to worry about anymore.
Public health challenges exist locally as well. In Dr. Pari’s lecture, we participated in an activity where we acted as public health officials in California counties. Specifically, we discussed how to assess the health needs of recently released prisoners. Not only did we come up with the prisoners’ possible needs (eg. mental health care and housing), but we also determined who the stakeholders were. I hadn’t thought of some of the stakeholders—lay people from the neighborhood where the prisoners are being released, local businesses that could hire the ex-inmates, and former prisoners were among the stakeholders brought up. Next, we came up with a plan of action that included measures like distributing surveys and getting data from the Census Bureau. We performed this activity in a short amount of time, but I understand now that the public health officials who perform Health Needs Assessments in real life have a daunting task that involves cooperation among many groups of people.
Throughout this class, I’ve learned details of public health that I hadn’t considered before. Public health needs to be addressed at multiple levels of organization – local, national, and global. I can believe how much of a necessity public health is in my own community. I come from a suburban area, San Jose, and attend university at USC, near an urban environment. Even the health needs between these two parts of California can be very different, and need to be assessed carefully in order to bridge the gap between health outcomes, which is why I believe the field of public health is so important. In order to take preventative measures and encourage healthy behavior for entire populations, extensive information, insight, and empathy are needed.
Melissa Ling is a junior from San Jose, California, majoring in Biological Sciences and minoring in Public Health. She is determined to become a physician and work to reduce health inequities in the US.
When I used to think of tropical diseases, or any disease for that matter, the word “sexy” never came to mind. I imagined a pitiful quality of life, a shortage of medication, or a doctor’s interaction with a dying patient. But, I have come to learn all diseases are not equally sexy. Through our learning at Oxford University, it became apparent that severe symptoms, shocking statistics, and publicity all play key roles in the “sexiness” of a disease. This sexiness translates into interest in the public, coverage by the media, and investment into research and management by wealthy donors.
However, as Dr. Tom Darton said bright and early in the first lecture on a Monday morning, “typhoid is not sexy.” He went on to explain that the symptoms are not obvious. It doesn’t tend to kill people. It’s not one of the “big three,” (malaria, tuberculosis, and HIV/AIDS) which have research money constantly poured into researching them. It also is not an illness prevalent in children, which is a major contributor to the current attention to malaria. People suffering from typhoid “suffer in silence.” They are absolutely miserable, but usually not to the point of death. They are just sick enough so that it seems like living might not be worth it, but they have to live through the pain anyways. The problem with this is that many people, researchers and donors included, do not recognize that there can be things worse than death.
As mentioned earlier, the manifestation of typhoid is not as impressive as some other diseases. Not to say that a giant goiter from iodine deficiency or the swollen legs of elephantiasis are “impressive” in the general sense of the word, but they are strong, visible symptoms that something is wrong. They signal to the outside world that that person is suffering. In this day and age, presentation is important. These symptoms and their effects impress people into donating money and time into research on potential treatments and cures. Take HIV/AIDS, for example. Everyone wants to find a cure because an estimated 34 million people are living with HIV. The malaria situation is similar, as it kills about 750,000 people per year, mostly children. These statistics are the driving force behind the desire to understand and research these diseases. There are willing donors and even more willing researchers. Typhoid, on the other hand, makes people withdrawn, internally battling the abdominal pain, headaches, discomfort, constipation, fever, lethargy, aches, and characteristic rash that are symptoms of the disease. Since these are not necessarily visible symptoms, it’s hard to observe the disease in others, and therefore harder to recognize suffering. Additionally, death is not always a common result; so many people fail to see the importance in finding a cure or a vaccine.
Not only are the symptoms less than interesting for most people, the transmission of the disease is very off-putting. Similar to cholera, typhoid is transmitted via the fecal-oral route. In layman’s terms, this means that it is carried in people’s feces and passed along when someone ingests infected feces. This usually occurs when water is mixed and contaminated with sewage. Sadly, one of the easiest fixes for typhoid would be giving people clean drinking water. Somehow, Coca-Cola has managed to be shipped to every corner of the world, but clean drinking water has not. There’s no monetary gain in figuring out a way to do so since the people who would benefit from clean water are unable to afford the costs it would require to transport the it there.
The lack of apparent sexiness in typhoid’s presentation and transmission has been the kiss of death in researching and understanding the disease. Donors, drug companies, and researchers do not want to put effort into solving a disease that they do not see as deadly and that the media has not deemed “interesting.” This can be for a variety of reasons, but the major driving factor is that the people who would be receiving the treatment would be unable to pay for it, so there is hardly any money in researching typhoid. As stated earlier, what many people overlook when it comes to typhoid is the idea that there are things worse than death. Living with some of the symptoms of typhoid is worse than death. But the lack of fascination in the disease makes that idea irrelevant.
This mentality is a hard thing to accept about the global medical community. It would be nice to think that researchers are donating their time and donors their funds because they want to better the world. Many of them do. But terrible diseases are overlooked or ignored because there is no glamour in finding a cure for them. It’s also hard to accept the long road that exists between an idea and reality. Drug testing can take years before medicines are available to the general public, and it can take even longer for prices and costs to be negotiated before the poorest, and usually those in the direst need, can afford to purchase the medicine.
The major reality check that I experienced from this lecture as well as others is that there are inherent pitfalls with every medical system. There is no perfect plan that can cater to everyone’s needs in a cost-effective and sustainable way. If there were such a system, most countries would already be using it. At first, this demystification of the glory of healthcare was hard for me to stomach. However, there are glimmering aspects of some medical systems that show that the good of the people is being considered. For example, the inclusiveness of medical care in the UK and the specialty practices available in the US are impressive benefits to those systems. These aspects need to be understood on a global scale and implemented both nationally and internationally to improve health care for all. However, the massive costs of healthcare in the US offset some of the impressiveness of the available specialists. Corruption needs to be addressed, and the greed of many doctors needs to be limited if we want to achieve a sustainable system. While my faith in medical and healthcare systems has changed, I still believe that, through education and communication, we can achieve a more cohesive global healthcare system that encourages consideration, care, and good practice in a cost-effective manner.
Kenzi Roof is a sophomore majoring in Neuroscience and minoring in Business Administration from Westport, CT. She hopes to enter medical school upon completion of her undergraduate degree.
With a hectic schedule that often consists of studying for tests, going to classes, doing research, participating in extracurricular activities, and working at my job, I often lose sight of my ultimate goal: becoming a pediatrician for underprivileged children. Upon coming on this trip, I hoped to regain the passion I temporarily lost in the commotion that is ultimately life.
After completing a week of classes here at the University of Oxford, I have not only gained knowledge from courses that cover such topics as malaria, typhoid, meningitis, health economics, vaccines, maternal and child health, and alternative medicine, but I have also had an indirect lesson on the passion in one’s intended field by the various doctors that come in to teach us about their exceptionally interesting topics.
Each of the doctors comes in to the classroom with enthusiasm to discuss the topic for the day. The doctors are able to translate their passion in the field to the instruction of the students in the classroom by providing an expansive description on the different tropical diseases, along with discussing their particular investment in the specific tropical disease. One particular doctor that lectured us introduced us to the wonders of alternative medicine. Dr. Merlin brought us out to the Botanic Gardens and was able to identify various plants that are able to cure many ailments. He made all of the students interested in learning about alternative medicine because he exuberated passion. I was so interested in this topic that I individually asked him how I could learn more and he explained that it is not something that you could specialize in nor is it something that universities usually teach and he had to learn it on his own. To know that Dr. Merlin was this passionate about alternative medicine, and the medical field in general, that he would teach himself to become essentially an expert on the various herbs inspired me! I want my passion for children and the medical field to extend beyond basic knowledge so that I am more aware of the concerns of children’s health.
It is not only the doctors that led me to a rejuvenated passion, however, but also the individuals I’ve met here. Here at Oxford, a maid comes in to clean the students’ rooms everyday, and I’ve been able to grow close with one of the maids, Bridget. Bridget told me that she takes the train everyday from her hometown and walks thirty minutes from the train station to Oxford in order to support her two sons. She ardently cleans the students’ rooms and does it with such a warm spirit, that I am humbled and am able to have a different aspect on the various duties I must complete. Her hard work and dedication are so inspiring and these attributes motivate me to work hard for my future profession and in my future profession.
Oxford has been such an incredible experience because I’ve been able to take courses on amazing topics that encompass tropical diseases, and I’ve also been able to gain passion from unlikely sources. I hope to be able to inspire others through my newfound outlook and hard work it will take to obtain my future goals of becoming a pediatrician for underprivileged children.
Rachel is a junior majoring in Health Promotion and Disease Prevention and is from Temecula, CA.