Bed Bugs, Public Health, and Social Justice: Part 1, a Call to Action

Article excerpt

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Introduction

Bed bugs (Cimex spp.) are ubiquitous in the global environment (Hwang, Svoboda, De Jong, Kabasele, & Gogosis, 2005). Bed bug infestations have increased exponentially in North America, Canada, Europe, and Australia since the late 1990s (Harlan, Faulde, & Baumann, 2008). Bed bugs (Cimex lectularius) are presently plaguing the hospitality industry, schools, and residential populations, and they are threatening all aspects of American life (U.S. Environmental Protection Agency [U.S. EPA], 2009a). Many large cities and small communities in Ohio already have been negatively impacted by rampant bed bug infestations (Central Ohio Bed Bug Task Force, 2010; Joint Bed Bug Task Force, 2008). Bed bugs are poised to become one of the major pests in households throughout the U.S., necessitating the attention of many local jurisdictions in the near future.

The resurgence of bed bugs is theorized to be caused by a plethora of contemporary social and physical factors, including increased international travel and immigration; changes in pesticide availability, formulations, and application methodology; pesticide resistance; and the public's lack of awareness of bed bugs and the ease with which they are spread (Hwang et al., 2005; Jones, 2004; Romero, Potter, Potter, & Haynes, 2007; Zhu et al., 2010). All bed bug stages (eggs, young [nymphs], and adults) act as stowaways that are passively transported in luggage, clothing, bedding, and furniture. Urbanization plays an important role since bed bugs are frequently found in dwellings with a high rate of occupant turnover, such as hotels, motels, hostels, dormitories, shelters, apartment complexes, and so on (Jones, 2004).

Despite the negative health implications associated with bed bugs, many public health agencies are reluctant to take responsibility for these parasitic insects. While the resurgence of bed bugs and their impact upon global populations are easily demonstrated, the efficiency of the bed bug as a vector of disease is not (Goddard & deShazo, 2009). This latter point has been emphasized by many local jurisdictions hesitant to respond to bed bug complaints, while simultaneously considering their manpower shortages and lack of regulatory authority (Richland Health Department, 2009; Rossi & Jennings, 2010).

This is the era of health determinant differentiation, however, with housing and the built environment recognized as dominant influences on health and associated mental health considerations (Friedli, 2009). The escalating global bed bug resurgence leaves the divided public health community in a precarious social justice position if the lack of response to bed bug infestations disproportionately impacts underserved populations. Based traditionally upon local regulatory authority, local public health jurisdictions in the U.S. may be ignoring, or choosing to avoid, the inescapable responsibility of protecting people at both the individual level and at growing community levels from the infestation of an "insect of public health significance (Harlan et al., 2008)." It is noteworthy that a recent opinion survey revealed that 90% of all respondents considered bed bugs to be a public health concern, and 73% indicated that bed bugs pose an environmental justice concern (Eddy & Jones, 2011). Our article provides an evaluation of the literature pertaining to bed bugs' effects on human health and their potential as disease vectors; public health agency and response to human habitation concerns; and social and environmental justice issues as they relate to underserved and vulnerable populations. We strive to draw recommendations for future discussion and potential revisions in policy relevant to the present global bed bug crisis.

Bed Bugs and Human Health

Bed bugs are small parasitic insects that feed solely on blood, preferably human blood. Bed bugs typically feed when their host is asleep, biting the host's exposed areas such as the face, neck, arms, and legs (Ter Poorten & Prose, 2005). …