When news erupts about global health threats, it might be easy to discount them as distant problems typically found in developing countries.
Zoom in, however, and you can draw many Spokane-area connections to the 2019 World Health Organization’s 10 threats to global health, ranging from vaccine hesitancy to flu pandemic risk.
Other global threats include Ebola, weak primary care, dengue, HIV, air pollution and climate change, fragile and vulnerable settings, drug resistance including to antibiotics, and non-communicable diseases from diabetes and cancer to heart disease.
When asked about the WHO list, Spokane Regional Health District’s health officer Dr. Bob Lutz said he sees a number of local connections.
“Almost every one of these can be brought down to a local level,” Lutz said.
Although dengue and Ebola aren’t major threats, those concerns can’t be altogether dismissed in the U.S., Lutz said. Florida and Texas have had cases of dengue, a mosquito-borne disease mainly in tropical areas.
The deadly Ebola virus is found in parts of Africa, but the Inland Northwest region has prepared for a worst-case scenario. Lutz points to a Sacred Heart special pathogens unit, and multiagency training on protocols for transferring and handling an Ebola patient.
Closer to home, a measles outbreak of nearly 40 cases near Vancouver, Washington – mostly in unvaccinated children – has raised alarms around the state, Lutz said.
He said the nation has some pockets where people are anti-vaccine for different reasons. This is particularly troubling to public health officials because such as measles that haven’t been around for decades because of steady immunization rates are re-emerging, he added.
Meanwhile, U.S. primary care and access widened under the Affordable Care Act, Lutz said, although concern exists over possible Obamacare pullbacks. Regarding HIV, state and local officials are working this year to decrease past stigmas, Lutz said. It’s a chronic disease with effective medications, including ones for prevention.
Here are some other threats Lutz lists as top Spokane concerns, along with a few global ties.
Spokane health threats
Top regional health threats include violence, lack of affordable housing and co-occurring disorders that involve both mental health and substance use, Lutz said.
He said violence is a No. 1 health concern, affecting families, intimate partners and children. It also includes elder abuse and bullying.
Co-occurring disorders have emerged as another statewide and national priority.
“A significant percentage of individuals who have substance-use disorder have mental health issues, and conversely,” Lutz said.
While the overall opioid crisis is a threat, so is the use of other drugs and substances.
“We are working to get in front of the opioid epidemic and the drug issues,” Lutz added.
“It’s not just opioids. We know we have a methamphetamine problem in our community. The greatest significant percent of individuals who use opioids co-use other drugs.”
Lutz said communitywide solutions also are needed for the region’s homeless who are in a fragile and vulnerable setting.
“If you don’t have housing, it predisposes you to a lot of these other unhealthy issues we deal with,” he said. “That’s why there’s a push for housing first, and if we get people housed, then we can address other social issues that often co-exist.”
Some parts of the U.S. are seeing lower vaccination rates, and certain states including New York and Minnesota have seen the first measles outbreaks in 30 years. Washington state is the latest to make news headlines for at least 39 cases of measles.
“We have been having daily conference calls with the Department of Health to monitor what’s going on in Clark County,” Lutz said.
“The recommendations have been that we reach out to our health providers in the community to identify those pockets of low vaccine rates to get the word out and make sure kids are getting vaccinated.”
According to county health district data, about half of 5-year-olds and two-thirds of 6-year-olds have completed all of the vaccines required for kindergarten.
Specifically for measles, mumps and rubella, 74 percent of Spokane County youth through age 18 have been fully immunized, Lutz said. The MMR vaccine comes in two doses, the first is typically given between 12 months and 15 months, and the second shot is usually between ages 4 to 6.
“If you have the two shots, it’s 97 percent effective,” Lutz said. “Essentially, measles was declared eradicated in the United States in the year 2000, and it’s only because of decreasing vaccination rates that we’ve seen outbreaks.
“Measles is incredibly contagious. If you are not vaccinated and you’re exposed to someone who has measles during their contagious period, you will get it. It’s one of those diseases we just haven’t seen.”
Pollution and climate change
Spokane has made strides in overall air quality improvements, but Lutz said state and local officials remain concerned about the frequency of regional wildfires causing hazardous breathing conditions. On Aug. 20, the city experienced the worst air quality in the nation as smoke flowed in from wildfires in British Columbia. All resident were advised to stay inside.
“We’ve been dealing with air quality issues because of wildfires for the last couple of years,” Lutz said. “We actually have a couple of task forces to address that and in trying to have consistent messaging.”
The leading causes of death in the U.S. are heart disease and cancer, says the Centers for Disease Control and Prevention.
Lutz said the SRHD has prioritized to help residents reduce their risk factors for cardiovascular disease with programs to quit smoking, lower cholesterol, control high blood pressure, maintain healthy weight and do exercise.
“We are big on focusing on those behaviors both personal and environmental that affect cardiovascular disease,” he said. “We know if you eat healthy and exercise regularly, your risks are decreased; if you don’t smoke, your risks are decreased.”
Looking at lessons of the past, the 1918-19 Spanish flu pandemic infected 500 million people worldwide, and it killed between 50 and 100 million people. In Spokane, the influenza outbreak killed 1,045 people and infected nearly 17,000.
Lutz said public health leaders are realistic that pandemic flu comes in cycles. A state plan is in place that the SRHD would implement if the CDC announces any pandemic flu concerns.
This resistance – the ability of bacteria, parasites, viruses and fungi to resist medicines – threatens to send us back to when doctors were unable to easily treat infections such as pneumonia and tuberculosis. WHO said the drug resistance is driven by the overuse of antimicrobials in people, as well as animals within food production.
“We know that too many antimicrobials, antibiotics, antiviral and antifungal medications are prescribed inappropriately, and unfortunately too many people think if they have a cold, they need an antibiotic,” Lutz added.
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