Last week I went to the doctor for an exam. He brought up the idea of population health vs. individual health.
Disclaimer: I’m not a medical doctor. You probably know this by now but I just want to reiterate that.
As a public health practitioner, our governing bodies, WHO, CDC, state and city health departments create guidelines that are population health based. The population health initiative in question during my doctor’s exam was a Pap smear. For my age group, Pap tests are recommended every three years if they are negative. If I had a history of ovarian or cervical cancer in my family, I would probably want to be screened more often. These guidelines are generally in place to scoop up people who have fallen out of regular checkups or medical care.
One of the most contentious cases of population vs. individual health is the v-w0rd. Yep, you guessed it…vaccines.
Vaccines are a fantastic population health measure. The smallpox vaccine helped eradicate the disease. The MMR and polio vaccines help prevent once deadly childhood diseases, and the HPV vaccine can prevent some of the HPV strains that cause cervical cancer.
However, not everyone can have or want or agrees with vaccines. There are several categories.
- People who have medical contraindications to vaccines (suppressed immune systems, allergies to vaccine ingredients, etc)
- People who are opposed to a vaccine because of religious or personal exemptions.
I work in a hospital (not clinical personnel) where I was required to get a flu shot unless I filed for an exemption. I got my flu shot willingly realizing that it may not cover all of the flu strains and I realize that vaccines have limitations.
The recent measles outbreak in California last year illustrated what happens when people are not vaccinated and the disease is spread effectively through a theme park.
Another illustration of population vs individual health was the recent findings of red and processed meats being carcinogenic by the WHO. We’ve known for years that eating large amounts of red and processed meat is not good for you…that’s not a surprise. What surprised me is that some people were saying that the level of causality was similar to that of smoking and lung cancer.
Now, as anyone who has taken an Epidemiology class will tell you…It took a long time to establish that smoking indeed causes lung cancer.
This video explains how experiments work and how research is compiled to create these guidelines.
What the WHO did is conduct a systematic review and meta analysis looking at all of the cohort (long-term studies,) Randomized control trials, and other studies and opinions looking at the topic and found that these types of meat seem to be carcinogenic.
So Sara, what’s your point?
These guidelines are great for promoting general population health but may be ignored or avoided by individuals. Our job as public health practitioners is to encourage healthy behaviors and prevent diseases. If we keep creating sweeping guidelines, there may be lots of questions about if it applies to everyone in the general population or not. There will always be exceptions to rule.
What we should do as public health professionals is the following:
- Educate people about how the research was done and what it means to them
- Link people to services that can help them become more healthy
- Evaluate these new strategies to see if they are only panic inducing or actually effective measures.
- These guidelines and public health issues are in the spotlight and we should take advantage of this moment to encourage disease control and prevention
The dichotomy between these two topics is something I struggle with, but it encourages me to keep researching and learning to promote better public health practice.