THIS I BELIEVE
Mark Keim, MD, MBA
Emergency medicine, Disaster medicine, Public health, Emergency management, Business administration, Public policy, Public speaking
I believe in public health.
Because of people like John Snow, I believe that disease does not occur randomly. Because of Edward Jenner, I believe that disease can be prevented, that we may act now to influence the incidence of future disease. And because of Edwin Chadwick, I believe that people should be protected from dangerous social and environmental conditions before these hazardous exposures cause disease.
I believe that social and environmental determinants of health influence modifiable risk factors for disease. I believe that public health’s role is to engage multiple sectors and community partners to generate a collective impact and improve these determinants of health and risk factors for disease. I believe in the 10 essential public health services and in public health’s purpose that includes prevention, protection, promotion, response, and equity of access and quality. I also believe that the highest degree of public health impact results from dealing with health determinants and risk factors compared with less effective clinical interventions, counseling, and education. Why do I believe these things? I do so because they are proven.
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And yet, to this day, public health has still not applied even these most basic principles and practices to address morbidity and mortality caused by disaster-related hazards. The current reactionary approach is expensive, with unproven effectiveness. There are no validated models for predicting disaster-related health risks. Most disaster-related epidemiological investigations assess victim demographics without correlation with other critical risk factors, such as geographical location and dose of hazardous exposure. Considered in John Snow’s terms, every year (for many decades now), we count the number of cholera cases without bothering to find the contaminated well, let alone remove the pump handle. More recently (after Hurricane Maria hit Puerto Rico, and the lack of COVID testing during the pandemic) some have noted that public health no longer even counts all the cases!
Over the past 50 years, the focus of the US approach to managing environmental health emergencies (as compared with managing infectious disease emergencies) has been mostly reactionary and curative, rather than precautionary and preventive. For this reason, we have very few measures of effectiveness for either public health preparedness or response after literally hundreds of millions of dollars in public and private investment. For this same reason, we should return to the basics of public health to address this health problem. And it is also for this reason that I write this book. Here I propose "emergency health" as a new paradigm that is better aligned with public health principles and as a more equitable and effective application of public health practice as applied to disasters.