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Click the start the download. Report this file. Introduction Public Health Schneider Flashcards Introduction to Public Health 4th edition Rent Every textbook comes with a day "Any Reason" guarantee. Full text is available as a scanned copy of the original print version. Blood banks reported that blood supplies were critically low because people wrongly feared that they could contract AIDS through donating blood. In a few well-publicized incidents, schools refused to allow children with AIDS usually hemophiliacs into the classroom.
A special telephone information number on AIDS, set up by the federal government, was swamped with 8, to 10, calls per day. Meanwhile, although controversy still restricted federal funding for AIDS research, biomedical scientists were competing to identify the infectious agent, which most scientists believed would turn out to be a virus.
Despite the ill repute of many AIDS patients, the disease was of great scientific interest, and the growing public concern promised to reward with acclaim and financial benefits the scientist who isolated the virus.
Just a year later, blood banks in the United States began screening donated blood, greatly reducing the risk to transfusion recipients and people with hemophilia. Now, more than 3 decades after the first reports on AIDS were publicized, most of the hysteria has faded, while many of the direst predictions have been realized. By the end of , more than 1 million people in the United States had been diagnosed with AIDS, and , had died.
The proportion of women diagnosed with AIDS increased steadily over the first 2 decades and then stabilized at about 25 percent. A great deal more is known about the disease. New drugs have miraculously restored health to some dying patients and offer hope that HIV is becoming a chronic, manageable condition rather than a progressively fatal disease.
However, there is still no cure, and long-term prospects for HIV-infected individuals are uncertain at best. The only prevention is the avoidance of risky behaviors. The question of how the government should respond to the AIDS epidemic raised some of the most difficult ethical and political issues imaginable in public health. Every new scientific discovery stimulated new dilemmas. Most of the controversies pitted two opposing principles against each other: the protection of the privacy and freedom of the individual suspected of being ill, and the protection of the health of potential victims at risk of being exposed.
This conflict is common to many public health problems. Historically, the protection of the public has taken precedence over the rights of the individual. Thus, the principle of quarantining patients with dangerous infectious diseases such as plague, smallpox, or tuberculosis has been generally accepted and upheld by the courts. However, in the case of AIDS, the issues were more complicated.
Because people with AIDS belonged to stigmatized groups who may have been exposed to the virus because of illegal behavior intravenous drug use or homosexual acts that were still illegal in many states , they bitterly opposed being publicly identified.
Gay men, who had only recently achieved a degree of liberation from public oppression, were very well organized politically; they effectively opposed some measures that would have normally been considered standard public health practice, such as reporting the names of diagnosed patients to the health department. They had well-founded fears of being discriminated against for jobs, housing, access to health insurance, and so on.
As HIV infection has become more controllable, much of the controversy has subsided. AIDS is particularly difficult for government to deal with because the only effective way to prevent its spread is to change people s behavior. There are precedents for governmental efforts at promoting behavior change campaigns to promote smoking cessation, use of bicycle helmets, and healthy diet and exercise but their success has been modest.
Generally, the weight of a law adds significantly to the government s success in promoting healthy behavior, as in the case of seat-belt laws and laws against drunk driving.
However, behavior that spreads HIV is very difficult to control by law; intravenous drug use is already illegal everywhere in the United States, and homosexual acts were also illegal in many states until the U.
Supreme Court declared these laws unconstitutional in From the beginning, public health officials recognized that AIDS could be prevented only by persuading people to reduce their risk by limiting their exposure, which requires convincing them to control powerful biological and social urges.
Beginning with the earliest attempts at AIDS education, conflict arose between the attempt to communicate effectively with people most likely to be at risk and the likelihood of offending the general public by seeming to condone obscene or illegal acts.
Conservatives argued and still argue that the only appropriate AIDS education message is abstinence from sex and drugs. Later he became an unexpected hero to public health advocates by taking a strong stand in favor of frank AIDS education. While stressing the importance of mutually faithful monogamous sexual relationships and avoiding injected drugs, he nevertheless advocated education about the advantages of condoms and clean needles, and he urged schools to teach children about safe sex.
In response, Senator Jesse Helms, a powerful conservative from North Carolina, denounced safe sex materials aimed at gay men as promotion of sodomy by the government and sponsored an amendment banning the use of federal funds to provide AIDS education, information, or prevention materials and activities that promote or encourage, directly or indirectly, homosexual activities.
Drug regimens introduced in the mids that are capable of controlling the damage the virus wreaks on the immune system stimulated new medical, ethical, and economic challenges. The drugs have side effects that may prove fatal for some patients and have long-term adverse effects in others. Complicated regimens for taking many pills per day have been simplified, but new problems of viral strains resistant to the drugs have arisen.
These strains may be transmitted to others. It took the science of epidemiology, the study of disease in human populations, to determine the basic nature of the disease and how it is transmitted. The biomedical sciences, especially virology and immunology, were crucial in identifying the infectious agent, determining how it causes its dire effects on the human organism, developing methods to identify virus-infected blood, and devising drugs that can hold the virus at bay.
Biostatisticians help to design the trials that test the effectiveness of new drugs and, eventually it is hoped, vaccines believed to be the greatest hope for controlling the virus. In the meantime, behavioral scientists must find ways to convince people to avoid actions that spread the virus. The politics of the AIDS epidemic shows the tension between individual freedom and the health of the community.
There is a strong tradition of the use of police powers to protect the health of the public in all civilized societies.
In the United States, there is also a strong tradition of individual liberty and civil rights. Politics determines the path the government will take in balancing these traditions.
Public health is not based on scientific facts alone. It depends on politics to choose the values and ethics that determine how science will be applied to preserve people s health while protecting their fundamental rights.
Cryptosporidium in Milwaukee Water In early April , an outbreak of intestinal flu struck Milwaukee, causing widespread absenteeism among hospital employees, students, and schoolteachers.
The symptoms included watery diarrhea that lasted for several days. Two laboratories reported to the city health department that they had identified Cryptosporidium in samples from seven adults. This organism was not one that most laboratories routinely tested for, but starting April 7, all 14 clinical laboratories began looking for it in all stool samples submitted to them and they began finding it.
Ultimately, stool samples tested between March 1 and May 30 were found positive for Cryptosporidium.
Cryptosporidium is an intestinal parasite that is most commonly spread through contaminated water. In people who are basically healthy, the severe symptoms last a week or so. The infection can be fatal in people with a compromised immune system, such as AIDS patients or people taking immunosuppressive drugs for organ transplants or cancer treatment. In Milwaukee, public health officials immediately suspected the municipal water supply, which comes from Lake Michigan.
They inspected records from the two water treatment plants that supplied the city, and suspicion immediately fell on the southern plant. The inspectors noted that the water s turbidity, or cloudiness, which was monitored once every 8 hours, had increased enormously beginning on March 21, an ominous sign.
On April 7, city officials issued a warning, advising customers of the Milwaukee Water Works to boil their water before drinking it. On April 9, they temporarily closed the plant.
Looking for evidence that the water was indeed contaminated with Cryptosporidium, they discovered that a southern Milwaukee company had produced and stored blocks of ice on March 25 and April 9. Testing confirmed that the organism was present in the ice.
Meanwhile, public health investigators were trying to determine how many people had been made sick by the contaminated water. Reasoning that only the most severely affected patients would go to a doctor and have their stools tested, they began a telephone survey of Milwaukee residents.
On April 9, 10, and 12, they called randomly selected phone numbers and asked the first adult who answered whether anyone in the household had been sick since March 1. Of respondents, 42 percent reported having had watery diarrhea, which was considered to be the defining symptom of the illness. In a more extensive telephone survey conducted on 1, people in the greater Milwaukee area between April 28 and May 2, 30 percent of the respondents reported having had diarrhea.
Half of the respondents whose water came from the southern plant reported the symptoms, while only 15 percent of those whose homes did not get water from the Milwaukee Water Works had been ill.
These individuals had probably been exposed at work or from visiting the affected region. Flaws in the water treatment process of the southern plant led to inadequate removal of the parasites.
After the problem was diagnosed, the southern water treatment plant was thoroughly cleaned, and a continuous turbidity monitor was installed that automatically sounds an alarm and shuts down the system if the turbidity rises above a certain level.
Cryptosporidium contamination is probably much more common than is recognized. Cryptosporidium was first recognized as a waterborne pathogen during an outbreak in Texas in that sickened more than 2, people. Nonetheless, according to the CDC, an estimated 4 million to 33 million cases of gastrointestinal illness associated with public drinking water systems occur annually.
Updating the infrastructure is expensive; but waterborne disease outbreaks are also expensive.