by Mary Zhu –
At the beginning of the 20th century, childbirth was dangerous and lives were short. In 1900, for every 1000 live births, 6-9 women died of complications of pregnancy and 135 infants died before their first birthday, a loss of more than one of every ten babies. By the 1950’s, these deaths were uncommon. The maternal mortality rate in 1997 was less than 0.1/1000 live births and the infant mortality rate by year one was 7.2 /1000 live births (1)(2). These changes are spectacular and unparalleled among improvements in all other mortality rates. Because of the salvage of infant lives, the expected life span at birth rose from 47.3 years in 1900 to 73.7 years in 1980, a gain of more than 26 years of life. More recently, a few additional years were added at the other spectrum of life; survival from the ailments of age (heart diseases and cancers) improved and life spans increased to 77.7 years in 2006 (3).
The past gains over diseases are reversible. Syphilis is a case in point. In the early 20th century it was a leading cause of cardiac and neurologic disease. Intensive public health campaigns were launched in the 1940’s with the newly discovered penicillin. By 1956, the infection rate decreased to 3.9 cases/100,000 age adjusted population. Yet this organism does not stay conquered; we continue to have successive epidemics of this disease as social norms change and our vigilance wanes. In 1990 the infection rate rose 5 fold, to 20.3/100,000; it reached a nadir in 2000, then increased in 2006 and 2007, when cases of congenital syphilis were also noted to increase. The complications of syphilis (infertility, tubal pregnancies, premature births and congenital abnormalities) are personally tragic but they are also socially expensive. Additionally, syphilis is a public health marker for other sexually transmitted diseases such as HIV. Congenital syphilis is a sentinel disease for the adequacy of preventive health and prenatal care (4).
With the above background, we can better evaluate the proposed budget cuts to the Health Department. Dr. Iser, Director of the Yolo County Health Department, in his report to the Board of Supervisors on 1/26/10, described reductions in the following services: the monitoring of high risk pregnancies by public health nurses, a decreased ability to respond to communicable disease, a reduction in childhood immunization clinics and the elimination of the tobacco cessation, syringe exchange, youth coalition programs and HIV testing in the county jail. At a later date, a worst case scenario included the elimination of key health department positions and of communicable disease control programs, with the exception of the Tuberculosis Control Program.
We could reverse a century of progress. It is important to note that contagion was only controlled. With the exception of small pox, none of the ancient scourges have been eradicated. Add to this the hazards of our times. Health and Human Services attributed 400,000 and 300,000 deaths annually to tobacco and diet/activity patterns, respectively. In 1990, these represented 19% and 14% of all deaths. Sexual behavior and illicit drug use were identified as the most rapidly increasing causes of death (5). Thus, we can expect increases in the associated problems of these behaviors: HIV, Hepatitis B and C as well as the sexually transmitted diseases of old. Collectively, tobacco, diet/activity patterns, unsafe sex and illicit drug use lead to destruction of the lungs, heart, blood vessels, liver, neural tissue, to diabetes and its complications, congenital malformations and compromised pregnancies and deliveries.
Yolo County has one of the highest rates of medically uninsured under age 65 (22%) in the state (6). This rate will likely increase, given our economy and the threat of major escalations of insurance premiums. It is estimated that government absorbs 75% of the medical costs of the uninsured (7) and our medical system is extraordinarily expensive. To cut public health programs that reduce the progression of risk factor to chronic diseases among the uninsured is the epitome of “penny wise and pound foolish.”
Lastly, microbes mutate/evolve to become resistant to antibiotics (multi-drug resistant TB), render past vaccines obsolete (H1N1) and cross host species from animals to humans (HIV, SARS). An effective, intact public health department is our protection against epidemics to come.
Mary M. Zhu M.D., Ph.D., M.P.H. is a representative from District 4 on the Yolo Health Council