Public Health Communication, Education for Potential Epidemics - Coursework Example

A Study of Public Health Communication, Education and Outreach, for Potential Epidemics 1990-2009 The history of epidemicshas been one marked by triumphs amidst tragedy, accentuating human courage as well as science. Public health awareness has played a pivotal role in fighting epidemics and curbing their spread. The epidemics of the last two decades include not only those that have been passed on from the late twentieth century, but also many other infections that can grow into epidemics due to a combination of factors that the changing times present. After studying the societal, public health and financial effects of the Black Plague and other grave epidemics of the yore like cholera, small pox and measles, measures can be devised to counter the threat of potential epidemics. One of the challenges to effective public health communication is that people take public health measures such as clean water for granted; individual treatment rather than societal prevention is overriding. Public health communication is aimed to market public health measures. The paper analyses how communication, outreach and education for public health regarding potential epidemics such as SARS, HIV/AIDS, cholera etc. have occurred in the time period 1990 to 2009. Keywords: public health, potential epidemics, interventions, communication, outreach, education A Study of Public Health Communication, Education and Outreach, for Potential Epidemics 1990-2009 The history of epidemics has been one marked by triumphs amidst tragedy, accentuating human courage as well as science (Barry, 2005). Countering an epidemic does not depend on the provision of vaccines and medication by doctors and scientists. It involves the concerted efforts of political figures and governments and cooperation by the masses. Public health awareness has played a pivotal role in fighting epidemics and curbing their spread. Health promotion is done by agencies and covers various problems regarding the epidemic (Kirch, 2008). Epidemiology refers to the study of public health. Public health, generally speaking, is the combination of organized efforts to safeguard and enhance the physical and mental well-being of the community. Therefore it extends beyond the study of a single individual and entails a study of how efforts help to raise the well-being and health of the community. Public health is not confined to giving health education and raising public awareness. It includes combating epidemics and chronic illnesses as well (US encyclopedia). Epidemic is defined as any occurrence of disease in individuals that exceeds the number of cases that are expected and normally encountered. More specifically, it is the widespread outbreak on an infectious disease in areas where it is not prevalent, or its rapid spread affecting people for a temporary period of time and then disappearing, and so is a public health emergency (Tulchinsky & Varavikova, 2009). Public health outreach and communication plays an integral part in the prevention of premature death from rapidly spreading infectious diseases. This paper explores the role public health has played in the combat against epidemics. It evaluates the communication, education and outreach of public health for potential epidemics during the period 1990-2009. The world is saturated with myriad viruses that infect living organisms. Many of these viruses can mutate and give rise to new strains. Many viruses that were thought to infect animals only have undergone changes and can be transferred into a human host and to reproduce in humans as well, infecting them. Where the mutation in the virus can make it benign, it can also cause an increase in the virulence. However, too much virulence is not in the interest of the virus, since it would be detrimental to the host and the virus would not be able to reproduce if the host dies early in the process. There are two main types of epidemics. Common source epidemics are usually the result of pathogens and microbes from a contaminated source e.g. water and human wastes. On the other hand, host-to-host epidemics are spread when the infection is transmitted from one person to the other through indirect routes. Due to these features, it has been seen that common source epidemics cause a surge in the number of infected individuals initially, with the numbers decreasing over time. However, the number of cases reporting with host-to-host infections increase gradually over time, and the fall in the cases is also slow. Common source epidemics which have been the cause of great concern in the past few decades include cholera, hepatitis and typhoid fever; host-to-host infections include whooping cough, tuberculosis, measles and influenza. A potential epidemic is one where a single case of a rare and contagious disease occurs that has never occurred before, or it has been a long time since it occurred in the community. Even a small number of cases in an area that does not favor the spread of the virus, e.g. typhoid cases in an area with good sanitation, are considered to be a potential epidemic. Epidemics are not necessarily caused by bacteria and viruses. The rapid consumption of cigarettes and the resulting respiratory diseases are also an epidemic of the twentieth century, as well as deaths due to coronary heart diseases in the males. Behavioral epidemics are also rising progressively in the recent years. Behavioral epidemics entail a rise in a certain attitude in the population. The increasing number of deaths in road traffic accidents due to addiction to high-speed is an epidemic of not only the twentieth century but also of the twenty-first century (Last, 2010a). The epidemics of the last two decades include not only those that have been passed on from the late twentieth century, but also many other infections that can grow into epidemics due to a combination of factors that the changing times present. HIV/AIDS, coronary heart disease and respiratory-related diseases such as lung cancer have been handed down as a legacy from the previous century; however, there are still some places where these epidemics have not broken out. Here these epidemics can pose to be a potential epidemic, and public health needs to be monitored in these areas. For instance, HIV/AIDS has evolved into a pandemic and has been found in all continents except in the Antarctica. Lung cancer and other smoking-related diseases were a potential epidemic in women in the last decade of the twentieth century. This was largely in cause due to marketing and campaigning by tobacco sellers. Despite the fact that tobacco is a very addictive substance, the widespread publicity of the cigarettes, coupled with influences from male tobacco-users, caused a surge in the number of women who smoked. It also attracted women and girls who did not have a history of smoking. As a result, deaths due to lung cancer rose steeply in the last two decades of the twentieth century. This was mainly the trend in industrialized countries. Lung cancer and tobacco-related diseases, along with coronary heart disease, can present as potential epidemics in the developing countries, where the number of women who smoke are relatively low. Last (2010b) contends that unprincipled and aggressive marketing campaigns similar to those carried out in developed countries are now being conducted on a large scale in developing countries in the early twenty-first century. He cites statistics presented by the World Health Organization that the annual number of deaths resulting from tobacco-related diseases could rise up to a number of 8 to 10 million worldwide by 2025; as a result, tobacco-related diseases could become a lethal epidemic disease that can be compared to the likes of the deaths caused by HIV/AIDS. Public health communication, education and outreach have continued to play a pivotal role in the prevention and intervention of potential epidemics. After studying the societal, public health and financial effects of the Black Plague and other grave epidemics of the yore like cholera, small pox and measles, measures can be devised to counter the threat of potential epidemics (Christakos, 2005). The World Health Organization, along with other organizations such as the Pan American Health Organization, has been involved in projects that promote health and are aimed to avert potential epidemics. One of the important aspects of preventing potential epidemics is prevention intervention, so that the spread of the epidemic is confined. For instance, in areas with a high prevalence of a disease, health education and prevention intervention can contribute significantly in the prevention of an outbreak of the disease in areas that do not have any case of that disease. Examples of HIV interventions are now common knowledge, since there are health education programs being conducted all over the world that raise the awareness amongst individuals regarding the disease. Communication for public health in AIDS is focused mainly on behavior change and in done through innovation, through channels, over a period of time (Edberg, 2009). Communication is not only carried out by visiting physically, but the Internet is also being used for the purpose. Efforts by Center for Disease Control and Prevention (CDC) and other agencies to reduce and eliminate the spread of HIV primarily revolve around evidence-based prevention programs. The implementation of these programs in mainly being done in traditional settings, where people are more prone to being infected due to lack of awareness about the disease. Education and communication regarding health are done through community-based programs and workshops, events and activities that are aimed to raise health awareness, public service announcements and print media. Mass media is one of the channels to deliver people information and to promote their understanding of HIV/AIDS (Lagerwerf, Boer, & Wasserman, 2009). The main theme of these programs has been the promotion of safer sex behaviors. Elaborating upon it further, case management of reproductive tract infection and sexually transmitted infection has been incorporated into local reproductive health programs, with promotion of knowledge and use of condoms, peer education, law enforcement sensitization, workplace interventions such as voluntary counseling and testing referrals and life skills training on sexuality and substance abuse (Moses, 2006). In awareness programs, teams have focused on the instillation of certain skills such as assertion, eroticization, negotiation and refusal skills in order to bring about a behavior change- an intervention to the AIDS epidemic (Edgar, Noar, & Freimuth, 2007). The Global Outbreak Alert and Response Network (GOARN) is an association of different institutions and networks, who collectively gather and organize human and technical resources for the swift identification, confirmation and response to outbreaks of international importance. The collaboration provides public health awareness, communication and outreach by and ensures its effect and longevity. The International Health Regulations (IHR) have been in effect since a few years and are aimed to “prevent, protect against, control and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international traffic and trade” (WHO, 2010a). The IHR protects and reduces public health risks from potential epidemics from infections including the Severe Acute Respiratory Syndrome (SARS). The IHR is playing an integral role in the monitoring of disease and support for countries where epidemics are causing thousands of deaths. The health threats of the early twenty-first century include bioterrorism in the form of anthrax letters in the US in 2001, the surfacing of Severe Acute Respiratory Syndrome (SARS) in 2003 and the large-scale dumping of toxic chemical waste in Côte d’Ivoire in 2006 (WHO, 2010b). Mass media has played an increasingly important role in the communication of public health during the times when these events were developing. According to the WHO, television, newspapers, magazines and the radio are the most influential means of dissipating information regarding health risks. Although it is a challenge for the media to communicate information on SARS or the avian flu, the media has dealt it in two main ways. The media explains and conveys to the public scientific facts and government regulations and measures regarding the health risk, and simultaneously, give coverage to the concerns of the public. Government press releases, scientific journals and scientists are the main channels through which public health information is communicated. Journalists have promoted effective health communication over the past two decades by bringing together information from reliable sources and presenting in easy terms. Politicians and other leading figures have conducted press conferences and have promoted health communication by describing the health conditions in layman’s terms. A study conducted by the Nuffield Trust highlighted the how public health communication was carried out during the SARS outbreak. If conducted with agility and skill, public health communication can help appease the masses regarding the health threat. Mass communications had been used during the SARS outbreak to restore confidence of the public as demonstrative by the instructive role of the WHO. The WHO was not only a trusted body that people believed in, but also the fast pace of modern communication played an important part in the outreach of public health. SARS showed how modern communication technology permits the swift exchange of information, facilitating better and effective preventative action (WHO, 2010b). From 1 May 2002 to 31 May 2005, 760 outbreaks of potential international concerns were identified by the WHO and other agencies working in collaboration. Seventy of these outbreaks were considered more urgent, and international assistance was sought. For fifty of these, international teams were organized and dispatched to various areas to give on-the-ground support. The WHO, along with other agencies, has been involved in the development and implementation of a comprehensive plan for managing outbreaks and epidemics. This is has been done by making comprehensive databases on epidemic intelligence, identification status of the pathogens, laboratory findings and operational information. Organizations have also been involved in keeping records of the outbreak history, and important actions and decisions taken by government and NGOs. Moreover, focus has been placed on the development of a logistic support system. Increased emphasis has also been placed on the effective outreach, education and communication of public health. In order to charge effectively against the pathogen causing an outbreak or an epidemic, the WHO requires countries to follow certain guidelines to build the trust of the public. Communication to the public regarding health can be across cultures, political systems, and rate of country growth. Moreover, another parameter for effective communication about health in potential epidemics is the prompt announcement of the disease. Communication should be candid and transparent, and must report all incidents clearly and without hiding any data on purpose. Effective public health outreach and education entails the bridging of the gap between experts and the public. This also necessitates an understanding of the opinions of the public. Over the years, this has been done on the strategies of communications surveillance, i.e. the communicator should understand the values, views and information that the public holds. In potential epidemics, knowledge about personal preventative measures has been proven to be effective in empowering the public in taking charge of their own health. From previous practices of health communication and outreach in potential epidemics, a risk communication plan has also been effective when integrated with risk analysis and risk management. These measures have been adopted in the outbreaks over the past two decades. They are aimed to counter the threat of potential epidemics in the current world, such as the influence pandemic. The WHO, in collaboration with other agencies, observes that the principal public health objective is to curb the outbreak as soon as possible, and with minimum social disturbance. It asserts that “effective communication is one way to achieve that goal” (WHO, 2005). The importance of public health communication can be judged by the emergence of the Nipah virus in Malaysia in September 1998. In the start it was misdiagnosed as Japanese encephalitis and the government made official announcements that the disease has been confirmed to be Japanese encephalitis. It launched and promoted public health measures to control the spread of the disease. These included mosquito fogging of farms and vaccinations. It took more than six months since the outbreak to discover that it had been a new pathogen that had caused the disease and that the disease had been misdiagnosed. All this time, the government had been spending its resources in treating the wrong disease. When it was announced that a misdiagnosis has been made, people lost confidence in the government, and felt that the government was insensitive to their worries and problems. The outbreak was brought to a halt by the culling of more than a million pigs, which put the livelihood of thousands of farmers at stake. It took the government millions of dollars to ensure the public that the health standards were being put in place and to win back the confidence of the public. The anthrax outbreak in New York City was a potential epidemic of 2001. The outbreak occurred right after the terrorist attack on the World Trade Center and infected eight people. However, it left a population of eight million in fear of the spread of the Bacillus anthracis. The disease spread through unopened envelops and necessitated the government to communicate about public health in a way that appeased the rumors that were rife regarding the disease. Advice to the public needed to be dispatched in a way that was up-to-date with recent developments and discoveries about the outbreak rather than the existing knowledge about it. Public health education was given in such a way that made it appear as if the government was in full control of the situation. Effective public health education and communication can be instrumental in the public collectively working together towards the application of prevention guidelines. Communication encompasses a gold standard based on a strategic approach that is carried through by stakeholders by delivering a strong and consistent message and by focusing on gaining public confidence and trust (Haider, 2005). The outbreak of SARS was dealt firmly with effective public health communication and outreach by the government. The government used both twenty-first century information technology with nineteenth century medical practices to counter the threat (Hooke, Rogers, Institute of Medicine (U.S.). Roundtable on Environmental Health Sciences, Research, and Medicine, & National Research Council (U.S.). Disasters Roundtable, 2005). The government realized that it was crucial to sustain its tourist industry, and an outbreak such as SARS can be detrimental to the economy of the country. The government saw public mobilization and participation in fighting the outbreak as a pivotal means of not letting its tourist industry come down. The way to gaining the confidence of the public and its participation was considered to be the provision of information and empowering them about the situation. The government did not hesitate to publish and report the details of the outbreak. The government reached out to the public through the media. Reporters used to inquire from government officials and scientists about the disease and voiced out the concerns of the public. They articulated the replies and statements of government spokesmen and scientists, publishing them in newspapers, broadcasting them on the television. The reports did not contain esoteric medical terminologies; rather they were published and broadcasted in layman’s language. This increased the knowledge and understanding of the public, and made them feel that they were not being left in the dark. Public health communication had a positive effect on the population and promoted to a more robust response to the outbreak. Swift and accurate reporting of facts, endorsed by the government, made people more sensitive to the role they were required to play in curbing the spread of the outbreak. Moreover, the public was motivated to apply prevention measures. The government conducted public health education by raising awareness about the use of masks, importance of good personal hygiene and quarantine and limitations of attending and visiting patients in hospitals. Outbreaks of viral hemorrhagic fevers have also been dealt with effective mobilization and engagement of the community. This has helped the outbreak from developing into a full-fledged epidemic. The outbreaks of Ebola in Uganda and Congo exemplified the challenges of public health communication. This was mainly because there were incorrect beliefs about not only the spread of the disease but also about the religious rituals that the locals performed. This caused a problem for authorities to reach out to the public and to enforce prevention measures. Since there was no information about cure or treatment measures, the government had to rely on protection of the community as the only solution of dealing with the emergency. The government had to reach out to communities that were hard to access and with low levels of literacy, having strong adherence to traditional and religious beliefs. Thus the government designed outreach and education plans that aimed targeted women. Women were considered to be the roots of the community infrastructure since they were the most prone to catching the fever because of their significant exposure to health care. Local information networks were made as well as tailoring educational messages to community beliefs and concerns (WHO, 2004). Ever since the 1990s, tailored communication is increasing being seen as a promising approach to addressing public health issues, and combines information and behavior change strategies to reach one particular individual (Spark, 2007). The response teams that were organized to deal with rumors about the disease helped to make the communication of information more efficient by using easy understandable language rather than medical terms. After the 1994 plague epidemic in Surat, measures were taken to prevent potential outbreaks from occurring. The post-plague management measures included proper disposal of human wastes as well as raising public health awareness. Households, industries and factories were given separate guidelines for maintaining cleanliness. Municipal sweepers were required to collect garbage from all houses and to take it to the nearest garage collection spot. All shops and commercial establishments were required to put a dustbin in front of their shop so that people do not litter, and are encouraged to keep the area clean. Eating places, such as restaurants and hotels, were mandated to use bins for collecting garbage and to dispose off it in the appropriate manner. On the level of residential occupancies, housewives were instructed by the response teams on the proper disposal of refuse. Moreover, the government organized awareness programs in slum settings about cleanliness and sanitation. The health ministry also took initiatives to reinforce the health infrastructure of the city, renew work ethics amongst health workers, prepare a management and monitoring plan and start an extensive cleanliness drive (Ghosh, 1998). There was also a cholera epidemic along the coasts of Peru that spread to parts of Latin America in the early 1990s. The government responded to it by giving health information, not only to residents, but also to travelers. People were instructed to boil water before drinking and to refrain from drinks that had open ice. They were encouraged to cook their food properly, so that the microbe is killed. Tourists were given guidelines to not to boy perishable seafood and to avoid purchasing food and drinks from vendors. Government officials ensured that water supplies are kept clean. Communication programs were targeted to inform people about the importance of eating food that was cooked properly and to avoid the consumption of fresh fruits, even in salads. Thus, public health education, communication and outreach are important for curbing the spread of potential epidemics. As Mr. Farr quotes, “the development of public health is a science and an art. It is the office of medicine to raise men up to a high standard of health, and not merely to heal the sick. Cholera only shows in high relief what exists in ordinary circumstances. Medical men rarely, if ever, treat the beginnings of diseases; and are scarcely ever consulted professionally on the preservation of the health of cities or families. But the preservation and the restoration of health are parts of one science” (Nourse, 1857). Outbreak of cholera in Iran in 2000 is also demonstrative of the role of public outreach through transmission of information through channels that were culturally appropriate. Culture can both serve to be a obstacle or facilitator of the epidemic (Hayden, 2009). The Iranian government launched a new plan which was aimed to inform the public about the disease. Effective communication is decisive to the success of programs that are specifically directed at health behavior change (Mullner, 2009). The information about public heath was based on evidence-based practice and prevention. It was transparent and the government avoided the use of technical terms unless necessary to make the guidelines more understandable. The program was founded on respect for the worries of the public. It entailed monitoring and care centers, as well as training and logistic support. In conclusion, the role of public health communication, outreach and education have continued to play a pivotal role in prevention of epidemics in the last two decades. One of the challenges to effective public health communication is that people take public health measures such as clean water for granted; individual treatment rather than societal prevention is overriding (Siegel, Siegel, & Lotenberg, 2007). They undervalue the importance of public health communication. All government plans are, in essence, aimed to sensitize the public towards the value of these measures. Former Surgeon General C. Everett Koop’s asserted on the importance of public health, “health care is vital to all of us some of the time, but public health is vital to all of us all of the time” (Novick, 2007). Reference List Barry, J. M. (2005). The great influenza: the epic story of the deadliest plague in history. Penguin. Christakos, G. (2005). Interdisciplinary public health reasoning and epidemic modelling: the case of Black Death. Verlag: Springer. Edberg, M. C. (2009). Essential Readings in Health Behavior: Theory and Practice. Massachusetts, MA: Jones & Bartlett Learning. Edgar, T., Noar, S. M.., & Freimuth, V. S. (2007). Communication Perspectives on HIV/AIDS for the 21st Century. New York, NY: Taylor & Francis. Ghosh, A. (1998). Management of Urban Environment. Retrieved from http://www.globenet.org/preceup/pages/ang/chapitre/capitali/cas/indsurat.htm Haider, M. (2005). Global public health communication: challenges, perspectives, and strategies. Massachusetts, MA: Jones & Bartlett Learning. Hayden, J. (2009). Introduction to Health Behavior Theory. Massachusetts, MA: Introduction to Health Behavior Theory. Hooke, W. H., Rogers, P. G., Institute of Medicine (U.S.). Roundtable on Environmental Health Sciences, Research, and Medicine, & National Research Council (U.S.). Disasters Roundtable (2005). Public health risks of disasters: communication, infrastructure, and preparedness : workshop summary. Washington DC: National Academies Press. Kirch, W. (2008). Encyclopedia of Public Health. Dresden: Springer. Lagerwerf, L., Boer, H., & Wasserman, H. (2009). Health Communication in Southern Africa: engaging with social and cultural diversity. Rozenberg Publishers. Last, J. M. (2010a). Epidemics. Retrieved from http://www.enotes.com/public-health-encyclopedia/epidemics Last, J. M. (2010b). Public Health. Retrieved from http://www.deathreference.com/Nu-Pu/Public-Health.html Moses, S. A. (2006). AIDS in South Asia: understanding and responding to a heterogeneous epidemic. Washington DC: World Bank Publications. Mullner, R. M. (2009). Encyclopedia of health services research, Volume 2. California, CA: SAGE. Nourse, W. E. C. (1857). A short and plain history of cholera. Retrieved from http://www.nlm.nih.gov/exhibition/cholera/pdf/9603098.pdf Novick, L. F. (2007). PUBLIC HEALTH ADMINISTRATION: PRINCIPLES FOR POPULATION-BASED MANAGEMENT. Massachusetts, MA: Jones & Bartlett Learning. Siegel, M., Siegel, M., & Lotenberg, L. D. (2007). Marketing public health: strategies to promote social change (2nd ed). Massachusetts, MA: Jones & Bartlett Learning. Spark, A. J. (2007). Nutrition in public health: principles, policies, and practice. Florida, FL: CRC Press. Tulchinsky, T. H., & Varavikova, E. (2009). The new public health. 2nd ed. Academic Press. WHO (2004). Outbreak communication. Retrieved from http://www.who.int/csr/resources/publications/WHO_CDS_2005_32web.pdf WHO (2005). WHO Outbreak communication guidelines. Retrieved from http://www.who.int/csr/resources/publications/WHO_CDS_2005_28en.pdf WHO (2010a). Global Alert and Response (GAR). Retrieved from http://www.who.int/csr/alertresponse/en/ WHO (2010b). The World Health Report. Retrieved from http://www.who.int/whr/2007/chapter3/en/index.html Read More