By Anders Gundersen, Research Assistant, HGHI

Public health infrastructure has been and continues to be influenced by the occurrence of epidemic/pandemic outbreaks, and the nature of our current public health system has been primarily shaped by past efforts in outbreak response.

For example, it was not until the third cholera outbreak of the 1800s in the United States that health officials in New York began to consider what might be causing these outbreaks and how they can be prevented. What followed were efforts to provide people with clean drinking water, which marked the beginning of industrial infrastructure for American cities.

Keynote speaker Alan Brandt noted that since the cholera outbreaks of the 1800s, we have experienced numerous health pandemics, including the Spanish flu in 1918, HIV/AIDS in the late 20th century, and Ebola in 2014 to name a few. While our infrastructural capabilities and our understanding of infectious disease outbreaks have drastically improved since our first attempts to understand and tackle them, there is still much progress to be made if we want to be a global society that is equipped to handle the epidemics of the future.

Brandt further elaborated by saying that even in recent years, epidemics have often been referred to as perfect storms; unpredictable events that we could in no way be fully prepared for. The Ebola outbreak in 2014 is a good example of this, but this perspective simply undermines our ability to handle these crises. Additionally, it is the perpetuation of these ideas that may lead to the lack of attention payed to infectious disease outbreaks by government organizations and others responsible for monitoring and responding to them.

This perception may be a large part of the reason that, despite all of the knowledge gained and epidemics experienced since the mid 1800s, our current government and health systems are not optimized for these events. When there is a common belief that nothing can be done, it is quite likely that nothing will be done; focus will be directed elsewhere. Evidence of this is the fact that when the U.S. military was assigned to assist with the Ebola outbreak in 2014, it took months for them to be properly trained, and by the time they arrived, the outbreak had ended and the infrastructure they brought with them was promptly removed. If our military is funded and trained to handle warfare, can they not also be funded and trained to handle outbreaks?

So how can we use this knowledge of the past to better guide our future infrastructural preparation for epidemics and pandemics? Our panelists noted a few different strategies for improving epidemic preparedness, such as training students in the history of these events.

Understanding what worked and what didn’t will help to limit the repetition of past mistakes. Additionally, understanding the political and cultural contexts in which an outbreak occurs allows for the implementation of the most effective solutions. In Mexico in the late 1970s, Mexico discovered oil reserves in the late 1970s and started to fantasize about being a wealthy nation. They sent people into the field with the goal of understanding what poverty meant in Mexico and attempted to develop solutions for it that were founded in education, housing, nutrition, and health. Point being that solutions are not universal and must be thought of within the context of the problem. Lastly, we must transition from our current model of handling epidemics, which is to be reactionary, and look instead to improving preventive measures, such as primary care and community health monitoring.

All of these ideas for improvement highlight an important point, that public health is in a state of incomplete professionalization. The basis of our public health model remains from beginnings of the industry, and we are overdue for a reevaluation of whether the same principles and practices that worked then are still applicable now, because only when the system is designed to address the problems we are currently facing can we begin to progress toward a society that takes epidemics seriously and handles them appropriately.

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