Treatment of illnesses in their full blown phases has become the norm both in Pakistan and in the US. This is directly linked to the de-funding of those agencies tasked to ensure public health hand in hand with the rise of private, for-profit health clinics and hospitals that operate to maximise their owners and shareholders’ profits
“One finger cannot lift a pebble” — Native American saying.
It is fall in Lahore, a time when the air conditioners are turned off, mornings are chilly, evenings are pleasant and weddings are in full swing. It is also, apparently, a time of fever, dengue fever to be exact.
As is usually the case with public health issues in Lahore, the response of both Lahore’s citizens and its authorities is a strange mix of indifference and panic. Banners have sprouted up on most of Lahore’s main roads, ostensibly from the city district government, urging citizens not to panic and to seek treatment promptly. Private hospitals are advertising this or that ‘specialist’ in dengue fever at their clinics, never mind the fact that treatment for dengue (like the treatment for most viral illnesses) is basically rest, lots of water, liquids and paracetamol or other painkillers (but not aspirin or certain ‘non-steroidal’ drugs such as ibuprofen, which can worsen the risk of bleeding).
Lost in all this is the fact that, like many communicable (and entirely preventable) diseases, dengue fever is basically a public health problem. Dengue fever and dengue hemorrhagic fever (DHF) are acute febrile (fever causing) diseases transmitted by mosquitoes, which occur in the tropics, can be life-threatening and are caused by four closely related viruses. It was identified and named in 1779. It is also known as break-bone fever, since it can be extremely painful. Dengue is transmitted to humans by certain kinds of mosquitoes and the mosquitoes that spread dengue usually bite at dusk and dawn but may bite at any time during the day, especially indoors, in shady areas, or when the weather is cloudy.
The World Health Organisation (WHO) estimates that 2.5 billion people — two fifths of the world’s population — are now at risk from dengue and that there may be 50 million cases of dengue infection worldwide every year. The disease is now endemic (meaning native to) in more than 100 countries. This year, Brazil, Colombia, Indonesia and the Philippines led the pack with the most cases.
So how is dengue fever a public health problem? While everyone is familiar with ‘health’, most people equate health with ‘my health’ or, at most, ‘our health’, by which they mean their family or the people they live with. Let us call this ‘individual health’. On the other hand, public health is “the science and art of preventing disease, prolonging life and promoting health through the organised efforts and informed choices of society, organisations — public and private — communities and individuals” (1920, CEA Winslow).
There are two distinct characteristics of public health:
It deals with preventive rather than curative aspects of health.
2. It deals with population-level, rather than individual-level health issues.
It should be obvious by now that anything that affects ‘communities and society’ is, by definition, outside the purview of any one individual, family or community. Thus the prevention and eradication of polio requires vaccination on a global scale since one patient can infect and re-infect dozens who can then spread it. The prevention and eradication of cholera or typhoid requires clean water and general sanitation to prevent the bacteria being shed by an infected person coming into contact with water or food that may be ingested by healthy people. It also requires controlling the spread of flies and other insects that can carry the germs from garbage to food. Since the primary agent of the spread of dengue fever is mosquitoes, it goes without saying that controlling their proliferation is the first step in controlling the illness.
In this case, one person, family or community, by spraying their locality with insecticides, cannot do the trick since the mosquitoes can easily migrate for a few days only to return later. Similarly, while informing oneself and one’s family of the need to avoid being outdoors uncovered at dawn or dusk (when mosquitoes are at their most active), not allowing stagnant pools of water to accumulate around one’s home or business etc is a good start, but without the active involvement and enforcement of the local government, not much can be accomplished.
Unfortunately, upon hearing this, our local leaders and politicians will invariably plead budgetary constraints to which there is a logical response. Treating dengue fever patients in public hospitals will be vastly more expensive and complicated than preventing the illness.
However, tertiary treatment, i.e. treatment of illnesses in their full blown phases has become the norm both in Pakistan and in the US. This is directly linked to the de-funding of those agencies tasked to ensure public health hand in hand with the rise of private, for-profit health clinics and hospitals that operate to maximise their owners and shareholders’ profits, not the health of the community.
While there is a place for private health, mainly as an add-on to basic, minimum public health services, for-profit health services can never replace public health for the simple reason that they are more expensive to deliver and cannot be accessed by a large proportion of the population. If poor people come into regular contact with those not so poor, disease transmission will occur since the dengue virus does not differentiate between victims based on their social class.
For all those who say we cannot ‘afford’ the basic services that exist in the West, the appropriate response is that as far as provision of clean water, basic sanitation and control of communicable diseases like dengue fever is concerned, these services are far more economical than hospital care. With a rising population, already having stressed energy, food and water resources and a war on our borders, it is high time we identified our true priorities and acted accordingly rather than eternally hoping for divine salvation.
The writer is a psychiatrist on staff at King Edward Medical University, Lahore. He can be reached at ahashmi39@gmail.com
“One finger cannot lift a pebble” — Native American saying.
It is fall in Lahore, a time when the air conditioners are turned off, mornings are chilly, evenings are pleasant and weddings are in full swing. It is also, apparently, a time of fever, dengue fever to be exact.
As is usually the case with public health issues in Lahore, the response of both Lahore’s citizens and its authorities is a strange mix of indifference and panic. Banners have sprouted up on most of Lahore’s main roads, ostensibly from the city district government, urging citizens not to panic and to seek treatment promptly. Private hospitals are advertising this or that ‘specialist’ in dengue fever at their clinics, never mind the fact that treatment for dengue (like the treatment for most viral illnesses) is basically rest, lots of water, liquids and paracetamol or other painkillers (but not aspirin or certain ‘non-steroidal’ drugs such as ibuprofen, which can worsen the risk of bleeding).
Lost in all this is the fact that, like many communicable (and entirely preventable) diseases, dengue fever is basically a public health problem. Dengue fever and dengue hemorrhagic fever (DHF) are acute febrile (fever causing) diseases transmitted by mosquitoes, which occur in the tropics, can be life-threatening and are caused by four closely related viruses. It was identified and named in 1779. It is also known as break-bone fever, since it can be extremely painful. Dengue is transmitted to humans by certain kinds of mosquitoes and the mosquitoes that spread dengue usually bite at dusk and dawn but may bite at any time during the day, especially indoors, in shady areas, or when the weather is cloudy.
The World Health Organisation (WHO) estimates that 2.5 billion people — two fifths of the world’s population — are now at risk from dengue and that there may be 50 million cases of dengue infection worldwide every year. The disease is now endemic (meaning native to) in more than 100 countries. This year, Brazil, Colombia, Indonesia and the Philippines led the pack with the most cases.
So how is dengue fever a public health problem? While everyone is familiar with ‘health’, most people equate health with ‘my health’ or, at most, ‘our health’, by which they mean their family or the people they live with. Let us call this ‘individual health’. On the other hand, public health is “the science and art of preventing disease, prolonging life and promoting health through the organised efforts and informed choices of society, organisations — public and private — communities and individuals” (1920, CEA Winslow).
There are two distinct characteristics of public health:
It deals with preventive rather than curative aspects of health.
2. It deals with population-level, rather than individual-level health issues.
It should be obvious by now that anything that affects ‘communities and society’ is, by definition, outside the purview of any one individual, family or community. Thus the prevention and eradication of polio requires vaccination on a global scale since one patient can infect and re-infect dozens who can then spread it. The prevention and eradication of cholera or typhoid requires clean water and general sanitation to prevent the bacteria being shed by an infected person coming into contact with water or food that may be ingested by healthy people. It also requires controlling the spread of flies and other insects that can carry the germs from garbage to food. Since the primary agent of the spread of dengue fever is mosquitoes, it goes without saying that controlling their proliferation is the first step in controlling the illness.
In this case, one person, family or community, by spraying their locality with insecticides, cannot do the trick since the mosquitoes can easily migrate for a few days only to return later. Similarly, while informing oneself and one’s family of the need to avoid being outdoors uncovered at dawn or dusk (when mosquitoes are at their most active), not allowing stagnant pools of water to accumulate around one’s home or business etc is a good start, but without the active involvement and enforcement of the local government, not much can be accomplished.
Unfortunately, upon hearing this, our local leaders and politicians will invariably plead budgetary constraints to which there is a logical response. Treating dengue fever patients in public hospitals will be vastly more expensive and complicated than preventing the illness.
However, tertiary treatment, i.e. treatment of illnesses in their full blown phases has become the norm both in Pakistan and in the US. This is directly linked to the de-funding of those agencies tasked to ensure public health hand in hand with the rise of private, for-profit health clinics and hospitals that operate to maximise their owners and shareholders’ profits, not the health of the community.
While there is a place for private health, mainly as an add-on to basic, minimum public health services, for-profit health services can never replace public health for the simple reason that they are more expensive to deliver and cannot be accessed by a large proportion of the population. If poor people come into regular contact with those not so poor, disease transmission will occur since the dengue virus does not differentiate between victims based on their social class.
For all those who say we cannot ‘afford’ the basic services that exist in the West, the appropriate response is that as far as provision of clean water, basic sanitation and control of communicable diseases like dengue fever is concerned, these services are far more economical than hospital care. With a rising population, already having stressed energy, food and water resources and a war on our borders, it is high time we identified our true priorities and acted accordingly rather than eternally hoping for divine salvation.
The writer is a psychiatrist on staff at King Edward Medical University, Lahore. He can be reached at ahashmi39@gmail.com
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