Infinite Lists: Infinite Public Health

Lists are definitely infinite. Perhaps this explains my abnormal disgust with categorizing, grouping, sorting, ranking, itemizing, and enumerating the things left to complete in a day, in a week, in a year. My realizations: the lists can expand endlessly with unachievable tasks. Humans have this compulsive need to visualize everything that we do.

Yet, lists seem appropriate when we are reminiscing on the pinnacles of our achievements, especially in regards to Public Health. We often overlook the successes in Public Health; they are silent victories, effective and unnoticed. In 1999, the United States Centers for Disease Control (CDC) published an article listing and praising the developments in Public Health in the 20^th Century. “Ten Great Public Health Achievements” recognized the startling trend that the average lifespan of persons in the United States had increased by thirty years over the course of the century. Our immediate assumptions salute medicine as the contributor to these values, but in reality, Public Health’s efforts made lengthened life even possible.

Why? Public Health explains. Over the past 100 years, the apogees have included:

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 Babies and Mothers

o   Family Planning

o   Fluoridation of Drinking Water

o   Recognition of Tobacco Use as a Health Hazard

Intuitively, these seem like medical advancement or social reforms. However, when we consider Public Health as a preventative medicine, intertwined with policy and the community, it becomes understandable how these are Public Health contributions.

It is impractical to gauge the importance of the different Public Health achievements because each success develops upon another. Controlling Infectious Diseases, for example, is a byproduct of the efforts to improve the sanitation and create clean water supplies. These provisions are rooted in changing policy and social norms. Similarly, Vaccinations, a medical marvel, also assumed the responsibility of being a preventative form of medicine, in the interest of protecting the global community. Poliomyelitis, Smallpox, and other common infectious diseases were either eradicated or controlled in the U.S. through the innovation of immunization.

Perhaps my cultural bias tempts me to discuss chronic infectious diseases; after all, having seen Indian poverty (even to a mild extent), accomplishments in preventative Public Health practices seem to address the most basic needs of a community. But, the CDC’s article seems to fail at addressing one of the integral aspects of Public Health: policy.

Several hundreds of policies have been created to structurally adjust society’s habits and create equal accessibility to Public Health. The disparities in Public Health access between different socioeconomic levels have best been approached through the United States War on Poverty campaign that advocated for the elimination of poverty throughout the nation. In the mid-20^th Century, the creation of Medicare, Medicaid, and the Head Start Program all attempted to address the increasing gap, a primarily Public Health issue. But even through a narrow understanding of Public Health, we realize that every success, as forgotten or as unknown as it may be, is something we all take for granted.

There is no way to categorize, group, sort, rank, itemize, or enumerate the successes of Public Health. Public Health is definitely infinite. And I still do not like lists.  

Fast Food Nation: A Reason for Chronic Kidney Disease

McDonald’s. Taco Bell. Burger King. Kentucky Fried Chicken. You name it. A stroll through Baltimore’s Charles Village may only feature a small sampling of the well-liked fast-food joints, but the Hopkins nest is an anomaly when contrasted to the dining habits of the rest of our nation. I admit, I have indulged in the occasional French Fry; however, for a majority of lower-class Americans, indulgence is not an incentive for dining out. In many neighborhoods, McDonalds, Taco Bells, Burger Kings, and KFCs supersede grocery stores as a cheap solution for a daily meal.

The reality is, though, that consuming processed and fast foods frequently augments the risk of contracting diabetes, high blood pressure, obesity, and cardiovascular diseases. In the simplest terms: inexpensive junk food is a Public Health nightmare.

Most of these processed foods are manufactured with additional phosphorous, an elemental mineral that is naturally present in dairy products, peanut butter, and beans. While phosphorous itself appears as a vital supplement for osseous growth and ATP production, it is also a contributor to the rising incidence of Chronic Kidney Disease (CKD) in the United States. Aggravated by diabetes and high blood pressure, CKD slowly paralyzes the excretory system’s function in removing the excess mineral wastes from the body. 2004 data from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) estimates 11.5% prevalence (about 23 million adults in the United States) of CKD, defining this medical issue as a primarily Public Health concern. Yet how do fast-food, phosphorous, CKD, and Public Health correlate? A recent study explores this question, with an epidemiologic approach.

Observing both the social and scientific side of Chronic Kidney Disease, Journal of the American Society of Nephrology had found a trend in the high incidence of CKD in black individuals in comparison to other ethnicities. Additive phosphates in cheap foods (to extend shelf-life) are known to increase the risk of other chronic diseases in CKD patients, yet the racial trends were incongruous.

The Chronic Renal Insufficiency Cohort Study (CRIC) featured 3,612 racially, ethnically, and socioeconomically diverse CKD patients. Contradicting previous observations, CRIC revealed that the blood phosphate levels in both black and white patients of a lower socioeconomic status were significantly high.

CRIC followed the observational and non-invasive counting, comparing, and concluding methodology of a cohort study. A common exposure was deduced, and multiple outcomes were linked to the multiple exposures successfully. But cohort studies can be limiting. The follow-up duration and the expense of conducting this study is restricted by the resources available and the impracticability of attaining a large or diverse enough group without the influence of bias. I cannot be completely convinced that CRIC was the most effective study; prescribing a suggestion (either extending the duration or increasing the studied population) may not be feasible because of the inherent weaknesses of cohort studies.

My occasional guilty pleasures in fast food are over (for the most part). But for people within impoverished communities who simply cannot afford the best organic vegetables or agave nectar sweeteners, fast food seems to be the only pleasure. How can we create Public Health policy and structural change to provide access to all?

The vicious cycle continues: our fast food nation is to blame.  

Mergenthaler 111: Defining Public Health

Blogging is just one of those many new ventures waiting to be explored by a timid college freshman looking to leave her minute mark in the world. Welcome to this freshman’s attempt at creatively expressing her escapades through her newfound passion: Public Health.

Like every good Indian child, I used to believe that being “Kavya Vaghul the doctor” was the most humanitarian difference I could make. I was naïve. One thing led to the next, as I found myself humbled in India, peering out the windows into the slums where people could somehow flash the most beautiful smiles in squalor. How was this possible? It became painfully clear to me that to satisfy my love for compassion, medicine, and everything in between, I would need to be part of the community, helping the community. So the adventure began: The IKP Centre for Technologies in Public Health. Rural villages. CHWs. Primary Health Centers. Mental health issues in Tamil Nadu. Qualitative studies. Interviews. Health Day Camps. Visits to unsanitary biohazard disposal sites. Immunizations. And a sense of fulfillment and pure happiness that I had never felt before.

The Epiphany = Public Health manifests my dreams.

Luck would have it that Johns Hopkins University offers an Introduction to Public Health class, my guide through the broad spectrum of the social, the scientific, and the endless facets in this field. Day one in class, and we were delving into our semester-long survey with the question, “what is Public Health?”

A few mumbles in the audience and dazed expressions didn’t yield much at first, but three words resonated clearly. Public Health was the prevention of diseases and policy with an altruistic approach in support of the community, a global community. Obviously, my understanding of Public Health is limited, but our discussion progressed, revealing the complexity of its layers. I quickly began to realize that Public Health could be about the environment in which a population resides, the amount of education and awareness within a specific region or the accessibility of quality medical services all under the umbrella of maintaining the health of an individual, their community, and their world.

Yet even in the most precise definition of Public Health presents a conundrum. The multiple disciplines within the field complicate our grasp of the breadth of the subject. The reality of it all is that Public Health is inevitably tied into everything we do, a collective effort, if you will.  

Of course, these efforts, like our lives, are all in a constant state of change with countless vicissitudes. It is this parallel that characterizes the intrigue of Public Health, for me at least. I’d like to be able to see the world, interacting with communities, understanding the implications of health care on an international level, providing education and access to medicine in the remote reaches of the Earth, and maybe in the process, even reconnecting with the zeal life has to offer.

My second row seat in Mergenthaler 111 could easily be my favorite spot on campus; after all, it is my portal to the world of Public Health.