2019 brought with it many troubling medical headlines: Epidemics like Dengue Fever, Chikungunya, and Zika continue to ravage tropical and subtropical communities and threaten to move North into the United States. Diseases like measles—which, not too long ago, were well controlled by modern medicine—have made a resurgence as parents forgo childhood vaccinations. Rates of vaping among teens and young adults have skyrocketed, bringing with them a surge in the incidence of a novel, vaping-related lung disease.
Headlines have only further deteriorated in 2020 with the emergence of the novel coronavirus (COVID-19), a pandemic the likes of which the world hasn’t seen since the Spanish Influenza of 1918.
Each of these issues is, of course, cause for public health concern. But when asked what he saw as the most pressing public health issues in 2020, Neil Maniar, PhD, MPH, professor of public health practice and the director of Northeastern University’s Master of Public Health program, didn’t provide an answer drawn directly from recent headlines.
Instead, he considers the greatest threats to global public health to be those which society has faced for decades, regardless of discrete developments and events; Threats which exist during times without a global pandemic, and which are exacerbated by—and exacerbate—those global crises when they do emerge.
Below, we examine the four public health issues Maniar identifies as having the most severe consequences in 2020 and beyond, and illustrate the impact of each as seen through the lens of COVID-19.
Top Threats to Public Health in 2020
1. Disparities in Healthcare Access and Outcomes
In the U.S. and abroad, many individuals—particularly those from vulnerable communities—still lack access to quality healthcare for a number of reasons. The high cost of care, lack of (or inadequate) insurance coverage, lack of available services, and a lack of culturally-competent care are all cited by the U.S. Office of Disease Prevention and Health Promotion (ODPHP) as contributing factors to this problem.
When individuals cannot access quality healthcare, the effects can be substantial. Unmet health needs, delays in receiving care, and an inability to receive preventative treatment commonly lead to a financial burden on both the individual and the healthcare system as a whole.
The ODPHP specifically notes a number of potential solutions to this challenge, including increasing insurance coverage, addressing disparities affecting healthcare access (such as race, ethnicity, age, sex, disability status, and sexual orientation), and increasing access to telehealth services in underserved communities.
2. Social Isolation
According to a recent national survey conducted by Cigna, social isolation and loneliness are becoming a major cause of concern. Approximately half of survey respondents reported that they sometimes or always feel lonely, and approximately 40 percent of respondents reported that their relationships are not as meaningful as they would like them to be.
While occasional loneliness is a natural part of life, sustained social isolation can have serious effects on an individual’s health. According to the National Institute on Aging (NIA), prolonged loneliness has been linked to increased risks of high blood pressure, heart disease, obesity, and a range of mental conditions. By some estimates, the effects can be as damaging as smoking 5 cigarettes a day.
Individuals of all ages and demographics can feel these negative effects of social isolation, but, according to Maniar, they are felt more strongly by the growing elderly population.
“Especially for the elderly, social isolation can impact everything from mental health to an individual’s ability to access healthcare or obtain basic essentials like food, water, and medications,” he says.
3. Violence and Trauma
More than 2,312 mass shootings have occurred in the United States since the 2012 mass shooting at Sandy Hook Elementary School in Connecticut. The impact of these shootings and other violent crimes (murder, physical or sexual assault, childhood abuse, etc.) is substantial, both for direct victims as well as those who did not directly experience the incident.
“Exposure to trauma can have a significant impact on health,” Maniar says. “When we think about the issue of gun violence, for example, it has an impact not just on the direct victims, but on entire communities as well. Exposure to trauma can impact brain development, especially in children, and have lifelong impacts on health.”
Potential short-term and long-term effects, according to the National Institutes of Health (NIH), include:
- Changes to the limbic system and its function
- Sleep disturbances
- Cognitive changes
- Destructive behaviors.
“This is not a new topic,” Maniar admits. “But it is becoming increasingly important and politically charged.”
4. Food Insecurity
Even in America, one of the wealthiest nations in the world, food insecurity and a lack of access to healthy and affordable nutrition is a major concern. According to the U.S. ODPHP, an estimated 17.4 million U.S. households were food insecure at some point during 2014.
Food insecurity can be caused by a range of factors. Low income and high food cost, for example, is a primary concern; over 31 percent of low-income households in 2016 were food insecure. Access to nutrition is yet another issue. Poor urban planning, a lack of public transportation options, and a lack of full-service supermarkets in many communities have given rise to food deserts—a term that defines communities with a lack of access to affordable and nutritious foods.
While food insecurity may lead to short-term and long-term hunger, the effects go beyond a missed meal. Chronic malnutrition and food insecurity have been shown to increase the risk for obesity and chronic disease in adults, as well as mental and developmental conditions in children.
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Global Public Health and COVID-19
In late 2019, COVID-19 infected its first human victims in the Chinese city of Wuhan in Hubei Province. In a matter of months, the virus has become an epidemic and ultimately a full, global pandemic, infecting more than 2 million individuals in 177 countries. As of April 15, 2020, the disease has claimed more than 130,000 lives.
The COVID-19 pandemic has underscored the importance of investing in public health infrastructure and public health systems,” Maniar says. “Not only [the] systems to identify as early as possible potential outbreaks of disease, but also the systems to respond to those diseases, [the] systems to educate the public, and all of the programs and policies that are designed to help individuals be as healthy as possible.”
The pandemic has played an important role in highlighting the top threats to our global public health outlined above. “The disparities that exist in communities across the country and around the world have really become much deeper in the context of COVID-19,” Maniar says. “We see this in terms of the lack of testing capabilities, challenges in terms of access to healthcare, and when we think about comorbidities or other poor health outcomes that individuals may have which amplify the risk of a poor outcome for the virus.”
However, while the disparities in healthcare have received much of the attention generated by the pandemic, the other threats discussed above have also been highlighted in their own unique ways. For example, Maniar notes that while our current response to COVID-19—which includes varying levels of social distancing—is critical to stemming the rate of infection and flattening the curve, this practice is likely going to amplify the social isolation that certain at-risk individuals might already be experiencing.
“Individuals who were already socially isolated going into this crisis are at a much higher risk of being severely impacted by social isolation. [This includes] the elderly, the handicapped, [and] those with underlying mental illness,” he says. “This emphasizes the importance of embracing virtual check-ins, telemedicine, and teletherapy—any measure that we can use to build and maintain connections.”
Similarly, Maniar notes that rates of domestic violence are expected to spike in the coming months as at-risk individuals find themselves spending more time with their abusers due to shelter-in-place requirements. “There’s a lot of concern that rates of domestic violence and intimate partner violence are going to [increase],” he says. “While the precise impact is not yet known, we’ll have a clearer picture of how the pandemic has impacted rates of domestic violence in the coming months. In the meantime, it’s critical that victims understand that they are not alone, and that even now there is help available.”
Questions of food security have also been raised, as global and national supply chains have become disrupted by the virus and overwhelmed by demand from a panicked public. In some places, the price of staple goods like eggs, milk, and meat has skyrocketed, exacerbating the effects felt by those already struggling to source affordable, healthy foods. “While many of us might notice these increased costs, our budgets can often absorb them fairly easily. For individuals who are already exposed to food insecurity, [however] the effects are much worse,” Maniar says. “Some of these basic staple foods are incredibly difficult to find right now. Store shelves are empty, especially in urban areas; people are afraid to leave their homes and yet unable to afford the premium that comes with using popular delivery services.”
What Comes Next?
When asked about the most critical steps for bringing the crisis under control, Maniar outlines three immediate steps:
Step 1. Implement Widespread Testing
Making this critical move, he says, will allow everyone who needs a test to get one—even those who are asymptomatic. He also notes that special care should be taken so that testing is widely available to underserved populations which have been demonstrated to be disproportionately impacted by the disease.
“We really need to make sure that we have these rapid response capabilities to these types of outbreaks so that we identify [them] early [and] have the infrastructure in place to test individuals for different infectious diseases,” he explains. “One of the challenges that we certainly face here is that once the first cases started emerging, we didn’t have the infrastructure in place to broadly test individuals in the population for COVID-19, and we still don’t. There are many many cases that are still undetected right now because we don’t have the capacity to test everyone who is suspected of having COVID-19.”
Step 2. Understand Where the Gaps Exist
Maniar describes how vital it will be for our nation to identify gaps in our existing public health infrastructure—on local-, national-, and international-levels—and take the necessary action to reinforce any weak spots, whether they are in detection, mitigation, or recovery.
“We need to have the capacity to be able to treat individuals who have COVID-19 while also maintaining our capacity to treat individuals that have all of the other health conditions that folks would normally go into a healthcare setting for,” he says.
Step 3. Address the Underlying Issues of Healthy Equity
Since these issues become amplified in the context of a pandemic, drawing attention to them now will allow the national and international community to better prepare to respond to the next threat, as well as the ongoing crises that we face.
“I think that piece is particularly important right now because, what we do know, is that the more severe cases of COVID-19 are among the individuals who have comorbidities, [including] heart disease, high blood pressure, diabetes,” he Maniar says. “[These are] conditions which disproportionately impact underserved communities, and which increase the likelihood of poor outcomes associated with these outbreaks.”
For this reason, he suggests that “as we think about how we are responding to COVID-19, we need to make sure that we’re addressing the issues of health equity and developing specialized mechanisms so that we alleviate health inequities rather than exacerbate them.”
How Healthcare Professionals Can Make a Difference
As Maniar identifies, effectively addressing each of these issues will require coordination of energy and resources at the local-, national-, and international-levels. As such, there are many potential paths for public health professionals to make a difference and affect real change in their communities during this time of global crisis and beyond.
One of the most important ways in which these individuals can get involved is by raising awareness and visibility.
“As public health professionals, we are obligated to make sure that people have the most accurate information possible, which they can use to inform their personal decisions as well as decisions which stand to impact society at large,” Maniar explains. “Public health professionals…can play a big role in nearly every step of the process—from research to innovation to practice.”
Prepare to Make an Impact
For individuals who are interested in working to address one of the issues or challenges outlined above, Maniar recommends pursuing an education that will arm you with the knowledge and expertise needed to be effective. A Master of Public Health (MPH) is one example of a degree that provides students with first-hand experience and knowledge that they need to make this kind of lasting impact in the field.
“Find a program that will allow you to learn more about the specific topics that interest you, and that you would like to work to address,” Maniar suggests, adding that, for professionals looking to make a difference in the scope of COVID-19 and beyond, this is the first place to start.
Wondering how you can make a difference and address these key public health issues in your community and beyond? Download our eBook, “Preparing for Emerging Public Health Trends” below, and learn about the steps you can take to make a positive impact today.