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List of “Public Health Issues” Appears To Be Growing

What Makes An Issue A “Public Health Issue”?

Judging from recent articles which have appeared in the mass media and medical literature on topics as diverse as bullying and hoarding, it appears that seeing social phenomena through the lens of public health offers benefits that many advocates seek. This raises questions about what the benefits of earning the "public health issue" label are, and what criteria must be fulfilled by a social phenomenon to be legitimately classified as a "public health issue".

Quick quiz:

As readers of The Epidemiology Monitor and public health scientists, which of the following phenomena do you think are a public health issue?  You may wish to revisit your answers after reading this article.

Racism                                   Yes or No

Computer Security                   Yes or No

Bullying                                  Yes or No

Harmful Alcohol Use                Yes or No

Online Pornography                 Yes or No

Adolescence                           Yes or No

Child Obesity                          Yes or No

Infertility                                 Yes or No

The Size of Soda Servings       Yes or No

Injury                                     Yes or No

Violence                                Yes or No

Marijuana Use                       Yes or No

Hoarding                               Yes or No

 

HIV in Fishing Towns              Yes or No

Trauma                                  Yes or No

Depression                            Yes or No

Teen age Pregnancy              Yes or No

Child Labor                           Yes or No

Adult Obesity                       Yes or No

All Season Tires                   Yes or No

Active, non-motorized

 transportation                      Yes or No

Guns                                   Yes or No

Gang Violence                      Yes or No

Climate Change                    Yes or No

Achieving a "Good" Death      Yes or No

A case has been made in various publications for all of these phenomena to be considered public health issues.  Among the recent cited reasons for positing a phenomenon as a public health issue are those listed below.  Read these reasons and consider whether or not to change your view about what is or is not a public health issue.

Issue

Reasons Cited

Racism

  • Psychological toll on black Americans causes stress related health issues causing them to die younger than white Americans.
  • Black Americans receive poorer health care
  • Research on Black Americans is underfunded.
  • People of color are underrepresented in clinical trials.
  • Poor Black Americans are being hit hardest by political resistance to implement the Affordable Care Act

Computer security

  • Individual action to protect yourself only gets you so far. You need a group response.

Bullying

  • It is widespread in the US
  • It is a multifaceted form of maltreatment
  • It is linked to a wide range of health issues and can result in injury, distress, or death.
  • There are risk factors for bullying or being a victim of bullying
  • It may be preventable.

Alcohol Use

  • It is a causal factor in more than 200 diseases and injuries.
  • It causes deaths.
  • It is harmful for others besides the drinker

Adolescence

  • We pay little attention to the health of 10-19 year olds.
  • Almost all adolescent deaths are preventable
  • Mental health challenges are the overwhelming problem for adolescents
  • Teenagers need adequate consideration and a voice in public policy

Injury

  • They are preventable
  • We want to approach problems in the community as a whole and not focus on individuals
  • Want to focus on prevention not treatment
  • Want to use many solutions

Size of Soda Servings

  • Sodas are bad for health. If you are ill, your illness has consequences for others.
  • Public health measures make life healthier and safer for everyone.
  • Makes the default choice the healthier choice.
  • The intervention is broadly inclusive and democratic.

Infertility

  • Unwanted childlessness causes significant sometimes life threatening consequences.
  • Prevalence is significant.
  • Often linked to preventable infections.
  • Recognition and treatment are neglected now.
  • Discipline of public health could contribute significantly to policy and programs

Violence

  • It is transmitted like a disease.

Gun Violence

  • The US has one of the highest rates of homicides in the developed world.
  • The US has an average of 88 gun deaths per day.
  • Every time a gun is used in self-defense, there are 4 accidental shootings, 7 criminal assaults or homicides, and 11 attempted or completed suicides.
  • The National Rifle Association specifically targets the public health approach.
  • Promoting reasonable gun policies does not make public health professionals anti-gun

Marijuana Use Legalization

  • It produces second hand smoke
  • It leads to schizophrenia, especially in teen boys
  • Driving while high should be discouraged.

Achieving a “Good” Death

  • Public health addresses the distribution of limited resources.
  • We can achieve better care with lower costs by avoiding unwanted aggressive care.

Trauma

  • It is the number one health public health issue of our time.
  • Unrelenting stress is linked to obesity, diabetes, depression, and suicide.
  • Teaching resilience can transform trauma.

HIV/AIDS in Fishing Communities

  • AIDS related illness and mortality are devastatingly high in some fishing communities.

Hoarding

  • A growing problem.
  • Epi studies suggest prevalence is 2-5 percent of the population.
  • It spreads pests and possible health dangers to the community.
  • Social service or other agencies have to use resources to clean houses people cannot afford to clean.

All Season Tires

  • Cold hardens the rubber in all season tires
  • They are unsafe in cold weather and dangerous in snow.
  • People are dying because of these tires.
  • Manufacturers are allowed to market tires as all season knowing they are unsuitable in cold weather

Childhood Obesity

  • It has a significant long term health impact
  • We do not have universally accepted definitions

Adult Obesity

  • We need to prevent it before it happens.
  • We need to create lasting change by making the healthy choices the easiest choices.

Child Labor

  • It is a global practice
  • It has many negative outcomes

Active (non-motorized) transportation

  • Everyone travels.
  • Transportation systems impact health.
  • Health should be considered in transportation and land use planning and decision making
  • It can produce health benefits and curb health care spending

Online Pornography

  • It is harmful in many ways—preventing healthy sexuality, disempowering women, leading to sexual violence and non-consensual sex.
  • It is so widespread as to be considered a crisis
  • If CDC got interested, we could have success in the way we had success with cigarette smoking
Climate Change
  • Rebranding this issue as a health issue rather than an environmental or national security issue might have more resonance for the average citizen.
  • It fosters a more emotionally compelling response since it focuses on the immediate implications a warmer climate could have on people's lives.
  • It provides a sense of hope that problems can be addressed and avoided.
  • Invoking health helps to bypass the political quagmire.
  • Doctors can have a potential impact scientists may not have because they can transcend political differences and we really care about what they say.
  • It can change the type of dialogue people have about climate change.
Gang Violence
  • It has a distressing impact on individuals, families, and communities.
  • The wider social-economic costs can be equally damaging.
  • It provides communities with the opportunity to rethink how services for young people are delivered and how public health funding can be used in a more flexible way.

A question posted on Researchgate last year resulted in the following criteria being offered for what makes an issue a "public health issue".  Read these criteria and see if they change your view about what is or is not a public health issue. 

1.   The concept of preventability—there are conceivable ways to prevent the phenomenon.

2.   High prevalence of a risk factor or disease.

3.   A rapid increase in incidence and prevalence.

4.   Cost of the disease

5.   Burden of disease

6.   Has the capability of affecting the population as a whole

7.   Will require group action to solve.

8.   Ability to recognize the problem unhindered by obstacles posed by culture, politics, lack of resources, or lack of effective measures. This set of criteria effectively requires that a phenomenon must be seen as culturally appropriate, politically acceptable, technically feasible, and financially possible in order to be or become a true “public health issue”.  ■

 


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