Philosophical Thoughts and Public Health

A philosophical thought: the individual versus society has been an eternal struggle. And even after centuries, there does not seem to be an adequate balance between the two. We value our freedoms, but we question how these very freedoms affect our community. Is it not a little oxymoronic to restrict freedom?

A little over a century ago, Aiken, South Carolina was asking the same thing. On August 19, 1909, the Supreme Court of South Carolina hosted the suit of Mary V. Kirk and H. H. Wyman and the Board of Health. Mary Kirk was afflicted with leprosy, which was thought to be a threatening contagion to the community. The Board of Health decidedly placed Kirk in compulsory isolation to hamper the spread of her infectious disease. Kirk refused to comply on the grounds that she had a non-contagious form of anaesthetic leprosy and was subject to isolation in an unhealthy environment. Consequently, the Board of Health adjusted their sentence to quarantine in the Aiken hospital. Stripped of her civil liberties, Kirk filed for injunction. After an appeal from the Board of Health, the courts still favored Kirk’s claims.

Individual freedom seemed to triumph in this case, as both isolation and quarantine were deemed inappropriate measures for Kirk, rooted in the concepts of what the two are. Isolation restricts the movement of and individual who has an infectious disease by separating the individual from those who are healthy. Isolation, in other words, is a restrictive measure for an individual who is already ill. Quarantine, though, is the restriction of the movement of an individual who has been exposed to an infectious disease and is susceptible to becoming infectious. Essentially, the difference between the two is that isolation is meant for separating the ill and quarantine separates the potentially ill; both, however, are meant as a preventative measure to protect the health of the population.

But, who decides when an individual must be placed in quarantine? This is where the controversy over the individual versus society comes into play. Typically, the governmental health departments are responsible for deciding when an individual should be placed in quarantine. The level of involvement can be categorized as federal, state, or local, but relies heavily on the severity of the infectious disease and outbreak. Protecting the health and welfare of the citizens is the primary objective of any governmental health agency. Yet, we question whether just having the knowledge and experience with the subject of infectious diseases legitimizes the government’s power over an individual. In cases in which an individual can compromise the health of an entire population, it seems logical that the society (or community) takes precedence over individual liberties.

When it comes to the question about superseding individual rights in favor of the community, there seems to be predestined conflict. In many ways, the health departments are most qualified to assess the need for quarantine, especially because of the amount of substantial research they have about infectious diseases. While it seems insensitive to make a decision for an individual, sometimes, it is important to consider the extent to which their illness can affect an entire community. Is it fair for any individual to suffer? No. But at the expense of infecting an entire population? This is when Public Health must take into account individual rights and communal rights. When an infectious disease is highly communicable, the individual must be quarantined as a protective method to prevent disease for a whole population. However, as was the case with Kirk, low-communicability does not justify an individual’s rights to be compromised by compulsory quarantine. Obviously, there is a very fine balance between the individual and their community.

A second philosophical thought: perhaps, as pessimistic as it may sound, the controversy between the individual rights and our communal rights may never be resolved. However, balancing the rights of both is just another task in the long list of Public Health to-dos.

A Lesson in Humanitarianism

Most of the time, we like to imagine that we are superlative humanitarians. We see it as our obligation to help those who are less fortunate than we are. No doubt, it is the quintessential connection between human beings that nurtures this humanitarianism and fosters our concern for our species. But even as we offer aid, we often overlook a society’s basic needs in quest of resolving what appears to be the most pressing matter. Yet, we are slowly beginning to realize that the elementary Public Health provisions are integral to bettering global health.


Global health’s inherent dependence on addressing the most basic necessities is a challenge, as Laurie Garrett’s 2007 article “The Challenge of Global Health” asserts. The past decade’s race to improve global health was plagued by the inadequacies in resources. However, the increase in philanthropic concern by both the public and private sectors has inspired generous donations that are directed towards high-profile health challenges. Seeking short-term progress, though, in fighting HIV, tuberculosis, malaria, and other contributors to high mortality is inefficient when health infrastructure cannot accommodate these resolutions. Garrett argues that even though foreign Non-Governmental Organizations (NGOs) and some individuals are pouring billions of dollars into projects that may not allow “the world’s poor to say what they want, decide which projects serve their needs, or adopt [their] local innovations.”


The global health issue is no longer monetary, but rather dependent on several factors that rely on the appropriate distribution of the money. Garrett notes that funding does in fact come with string attached based on the “donors’ priorities, politics, and values.” Inefficiencies in allocating funding can be attributed to money getting trapped within bureaucracy, poor coordination of donor activities, and “stovepiping” (the funneling of money into a very specific cause that reflects the interest of the donor). Throughout the article, though, Garrett seems to emphasize the overarching dilemma: inefficiency in healthcare systems.


The fundamental issue, despite the mass influx of money, can still be traced to the lack of concrete healthcare infrastructure. Even developed countries are faced with a shortage of medical professionals, as the aging population demands more. This in turn requires talent to be harvested from the developing countries, which have an equally underdeveloped healthcare system. When healthcare resources are taken from countries where they are most necessary in preventing global health diseases, creating health infrastructure in these developing countries seems nearly impossible. The result is a vicious cycle of a decline in the progress of Public Health. The lack of infrastructure in the health sector must be addressed in order for any of the other global health issues to be resolved. Simply, without the facilities to cope with any health needs, health issues themselves cannot be approached.


Garrett specifically looks at two indicators in gauging the efficacy of health care systems in all countries, with hopes of losing the hodgepodge of targets in favor of focusing on more urgent needs. Garret’s basic goals are to increase maternal survival and overall life expectancy. Through increasing these two factors, we can hope to see improvements in the total population’s health. Though maternal survival may seem like an arbitrary measure, it is important and evaluating the health provisions that a country has. When there are facilities that can provide around the clock care that is sterile and safe, maternal morality rates will drop, thus suggesting that appropriate provisions are made. Similarly, overall life expectancy encompasses infant mortality because “where the water is safe to drink, mosquito populations are under control, immunization is routinely available and delivered with sterile syringes, and food is nutritional and affordable, children thrive.” Consequently, the environment can adequately support other Public Health ventures.


But the fact of the matter is that in developing countries, these markers need to rise prior to implementing the visions of stovepiping donors. Current faulty practices and lack of sustainability in efforts is a direct consequence of the problems that hinder global health progress. For example, several donors put their funding into HIV and AIDS resolutions in impoverished districts in South Africa. Insufficient clinics and health infrastructure is the primary hindrance to these initiatives. And this inability to treat patients has made them susceptible to a mutated form of tuberculosis (XDR-TB) that is resistant to antibiotics. Similarly, as a result of uncoordinated donor activities, the several different groups all working on fighting the HIV epidemic allocate their money directly towards these efforts, not realizing that those who are HIV positive are equally at risk for contracting malaria, as having one exacerbates the other.


We are a humanitarian society; however, we frequently forget that we are not only trying to protect our own communities from the spread of global diseases, but we are also trying to cater to the needs of the populations it is most drastically affecting first. Global health issues can only be resolved by addressing the most basic needs – needs that only the very people they affect can tell us. As we become an increasingly globalized society, the human connection is inevitably intertwined with Public Health.

Trypanohobia: Vaccines Aren't That Scary

Trypanohobia: an inexplicable fear of medical procedures involving needles. While most of us cannot be categorized as trypanophobic, receiving injections are not typically cited as pleasant experiences. Yet the countless vaccinations, the seemingly endless booster shots, and the growing numbers of recommended inoculations must all have been worth the cringing faces and sore biceps.

Undoubtedly, vaccines epitomize Public Health’s concern with preventative medicine. And undoubtedly, vaccines are a contributor to the grand conquest of several infectious diseases. However, a recent article in the Washington Post details the resurgence of whooping cough, a once-quelled infectious disease that is no longer a “whimsical memory.”

Whooping cough (pertussis) is caused by Bordetella Pertussis, a bacterium that propagates in the respiratory tract to release toxins and conduce sharp intakes of breath followed by oxygen-robbing coughs. As an unfortunate right of passage for young children, pertussis claimed up to 10,000 lives per year in the United States. But the 1940’s whole-cell vaccines (using deactivated pertussis bacteria) and the acellular vaccine (containing purified pertussis proteins) effectively reduced the number of whooping cough cases in the U.S. by 99%. This undeniable efficacy, though, is undermined by the whooping cough’s cyclical nature. Recent cases in California reveal the concerning rise in number of pertussis cases, especially when most children have been vaccinated.

The persisting presence of the whooping cough can be attributed to several factors, as cited by the article. Acelluar vaccines for whooping cough only guarantee 80-90% efficacy. Additionally, Bordetella Pertussis can be manifested in lighter forms even when patients have been vaccinated. Newer theories have determined that the certain strains of pertussis bacterium have evolved resistance to the vaccine-induced immune responses. But the most resolvable reason for the resurgence of the whooping cough arises from parents’ exercised option to refuse vaccination for their children.

The decreasing number of immunizations for whooping cough, and even other infectious diseases, can be attributed to the concept of herd immunity. Herd immunity occurs in a population when a significant portion of vaccinated individuals protect the unvaccinated inadvertently; when a large population is vaccinated, the infectivity of the pathogen amongst the population will decline. As the number of vaccinated individuals in a population increase, the transmission of the pathogen from infected individuals to others will reduce.

After a certain number of individuals in a population are inoculated – herd immunity threshold – the disease will cease to persist within the population. In the case of the whooping cough, 92% of the population must be immunized for the threshold to be reached (CDC). When those vaccinated sinks below this threshold, the population’s collective immunity is compromised, and pertussis can make a comeback.

But why would the number of vaccinated individuals decrease over time when vaccines are generally effective protective measures?

The prevalence of whooping cough in young children has been rising throughout the nation, and this new trend can be traced to multiple contributing factors on a personal, socio-economic, and even political level.

Controversies about the efficacy of vaccines have lingered, as many parents fear for the potentially negative health effects they may have on their children. Scares about autism or other ramifications of immunizations have altered parents’ perception of the necessity of vaccination. Parents’ general refusal of vaccination for cultural reasons or personal beliefs also compromises the child’s health. Herd immunity, in this context, is not enough to protect a child from contracting an infectious disease if the population immunized drops below the threshold.

Blame cannot solely be placed on the parents, considering that Public Health measures rely on the network of the community. Health care providers and physicians are equally responsible for declines in immunizations. When physicians do not adequately educate their patients about the importance of being vaccinated or explicitly share the associated risks of vaccinations, parents will be less inclined to have their children vaccinated. Unclear distribution plans and incomplete studies about different vaccinations also hinder the system, as more bacteria are forming resistance to treatments.

The overarching healthcare system, though, is a major contributor to the failure to keep vaccinated population levels about the threshold. Patients who have limited access to affordable healthcare cannot readily vaccinate their children. Without these provisions, levels of vaccinated children drop. Political regulations that allow parents to opt out of vaccinating their children further increase their child’s susceptibility to infectious diseases.

Yet, from a Public Health standpoint, what can be done to prevent outbreaks of infectious diseases? The answer is multifaceted.

It involving a combination of educating the public about the importance of vaccination in prevent diseases, creating mandates in policy that require individuals to be immunized, and offering services for the impoverished to get inoculated.

Trypanohobia. Yes, we may have a fear of needles for our various reasons. But vaccines are Public Health’s way of allowing us to exist on this planet in good health - worth every cringing face and sore bicep. 

You Smoke, We All Smoke: An Environmental Health Issue

There are so many Public Health ventures (for lack of a better term) in this world that we take for granted, especially here in our coddled milieu of the United States. Memories from my childhood detail very few instances of worry for my health and safety within my community. Yet, passively inhaling second-hand smoke has always piqued my aggravations. My educational conditioning opened my eyes to smoking’s potentially adverse health effects, half scaring me into a disgust of cigarettes and tobacco. Over time, Public Health measures, an amalgam of media, public policy, education, and resource allocation, has influenced the United States’ dependency on tobacco products, significantly reducing our exposure to passive and even direct smoke.

These same initiatives, though, have not been adopted by other countries in our world. Smoking has become an inherent part of many cultures; however, studies have consistently indicated that even non-smokers exposed to smoke have a higher risk for developing lung cancer. Takeshi Hirayama’s study – “Non-Smoking Wives of Heavy Smokers Have a Higher Risk of Lung Cancer: A Study From Japan” – followed 91,540 non-smoking Japanese wives between 1966 and 1979, monitoring their elevating risks for contracting lung cancer in correlation to the smoking habits of their husbands. Each individual over forty years of age was interviewed to find cigarette smoking practices (heavy smokers versus light smokers), alcohol consumption rates, occupations, and marital statuses over the course of the fourteen years. The study discerned a total of 346 deaths due to lung cancer, of which 174 were married women who didn’t smoke.

The results were conclusive: the dose-response relationship confirmed a relationship between the level of smoking and risk for lung cancer in the wives exposed – the greater the exposure (heavy smoke exposure), the greater the risk for developing lung cancer. The study even observed different classes and cultures within Japan, notably the urban versus rural populations. A greater risk for development of lung cancer in non-smoking wives within rural populations was evident, probably attributable to the increased hours of exposure to second-hand smoke in rural society. For all populations, though, the risk of lung cancer increases, not the incidence because cancer is randomly activated.

This cohort study was observational and in many ways advantageous because of the reduction of recall bias and the large groups of populations that could be followed. The variance allowed for an increased collection of data within several groups, which could finally be compared and assessed. Essentially, Hirayama’s study cites passive smoking as correlated to the increased risk of lung cancer.

Passive smoking, whether in Japan or another country, is an environmental health issue because of this very fact. Cigarettes and other tobacco smoke-based products, which directly affect the smoker, are inadvertently released into the air, a shared “commons,” if you will. The carcinogens burned in a cigarette are agents carried through the vector of air attach to particles, all of which we inhale. Consequently, even if we make the purposeful and personal decision to not to smoke, we can still be exposed to the toxic chemicals carried in a cigarette. This renders second-hand smoke as a compromiser of the community’s environment, and subsequently our health. As proven by Hirayama’s study, our exposure to even passive smoking can substantially increase our risk of developing lung cancer.

Even though evidence is there for the increased risk of development of lung cancer, smoking cannot cause lung cancer; it can only make us more susceptible to developing it. Correlations in this study and in others have shown that the risk for development of cancer and the continued exposure to second hand smoke might actually be a cause of lung cancer. This is supported by the small fraction of lung cancers attributed to chance. Cancer is random, though. Yet, reducing any risk of contracting it is a Public Health initiative that must be taken.

Smoking not only affects the health of an individual, but also the health of the community. And even if it may be my personal bias that interferes with my objective thoughts, direct smoke and passive smoke alike will continue to be environmental health issues until Public Health measures are accepted globally. 

The World's Chronic Disease: Individuality versus Globalization

Can we really foster individuality? The right-sided, creative, artistic, and philosophical brain in me dares not question the inherent uniqueness of every individual that walks this planet. Yet, it is also an inherently human characteristic to investigate the commonalities that bond and connect us all. “I am unique – sort of” has never been more applicable.

We course through the twenty-first century with our modified vision of coexistence: globalization. Our economies, societies, and even cultures have become helplessly intertwined in the global network, as advancements in communication and technology have surpassed our humblest expectations.  We inevitably forgo our singularities when we trade them for our commodities, customs, and diseases.

Despite the numerous scientific and medical achievements over the past two decades, all trends point to “the relentless worldwide spread of non-communicable diseases.” Globalization arguably trademarks the burgeoning awareness of global health, a field that seeks to examine the concerns of Public Health on a worldwide scale. The New England Journal of Medicine’s 2010 article “Global Noncommunicable Diseases – Where Worlds Meet,” contemplates these very implications for health on a global level through the lense of prevention, policy, and community.

Globally, the article emphasizes that the six leading risk factors for developing a non-communicable disease are “high blood pressure, tobacco use, high blood glucose levels, physical inactivity, overweight or obesity, and high cholesterol levels,” all of which directly correlate to the rising levels of mortality rate from chronic disease. The revelation is simple: despite the socioeconomic, cultural, and political differences between countries, non-communicable diseases, risk factors, and health-related issues can be frighteningly uniform. Non-communicable diseases are no longer linked to an individual’s income, but rather attributed to the increased globalization of our world. Even developing countries suffer from the impressing “epidemiologic stage and behavioral transition” that couples non-communicable diseases with the existing burdens prevalent in low-income countries.

The vicious cycle, the everlasting burdens in Public Health, connects health with the economy. As the rates of non-communicable diseases increase globally, so does the need for expensive tertiary treatment options with ramifications on the financial sector. But why grapple with disease when we can take measures to prevent it in the first place? The New England Journal of Medicine asserts that solutions are at the “levels of policy, health care delivery, health communication, and education.” “Proactive, preemptive intervention, and participation” are the integral efforts that will adequately confront the communication of disease by our global media and lifestyles.

However, we begin to wonder how a disease that once primarily affected the affluent can become a commonality to all. The reality is that globalization is to blame for the overlap between risk factors for death in the richest and poorest of countries. Developing countries that once did not have access to the western media or the “luxuries” of inexpensive products now do because of the interconnectedness of our trade. Developing non-communicable disease risk factors relies heavily on the environment that we live in. As our commodities and cultures become homogeneous through the process of globalization, it becomes clear why we are all equally prone to any disease.

The commonalities of chronic diseases worldwide can be observed through osteoporosis, a bone disease that typically develops in postmenopausal women and causes an increased risk of fracturing in porous bones. Biologically, the bone mineral density is reduced dramatically due to either hyperparathyroidal issues or increased protein intake (which reduces the calcium present). 75 million people worldwide are inflicted with osteoporosis, yet with simple Public Health measures, it is highly preventable.

Primary Prevention – an intervention to prevent the onset of a disease in anyone – would advocate lifestyle changes in nutrition and exercise. A Secondary Prevention – eliminating the maturation of risk factors in those who are prone to a disease – would call for increased screening of women and men and the distribution of therapies and medication for who are at risk for developing osteoporosis. And Tertiary Prevention – addressing those and treating those who have the disease – would entail providing greater access to antiresorptive agents or bone anabolic agents to heal those who already have osteoporosis.

Yet, it is important to take into account the vast majority of people in this world, reconsidering our differences and our uniqueness, once again. While it may be simple for us to suggest using these preventative methods for osteoporosis or any other chronic disease, resources may not be available everywhere due to the socioeconomic gaps and the mere understanding of what health need (or even basic need) is a priority.   

So, can we really foster individuality in our globalized world? With efforts in Public Health to prevent diseases, we can definitely try and preserve it in as many ways as we can. Yet, our individuality ironically depends on our unified undertakings. I want to be connectedly unique – definitely.