Academic journal article Journal of Environmental Health

The Responsibility of Occupying the Front Line

Academic journal article Journal of Environmental Health

The Responsibility of Occupying the Front Line

Article excerpt

Good health, one of humanity's most cherished goals and the goal that drives our profession, can be achieved only in one of two ways. We seek to maintain good health through effective prevention practices that individuals and communities undertake. We can often restore good health through the remedies offered by modern medicine.

Public health and environmental health represent the front line of the community prevention effort. Modern medicine moves into action only when we have failed to prevent a problem and the need to restore health comes into play.

It is often the case that society sings the praises of modern medicine inasmuch as this last line of defense may gallantly come to the rescue and restore health once it is lost. Modern medicine doesn't always work, however. Moreover, there are, unfortunately, many afflictions on which the miracle cures in modern medicine's bag of tricks have no effect. When we are threatened by an affliction for which there is no cure, public health and environmental health not only constitute the front line of protection for health; they constitute the only line.

The stakes for our profession are incalculably high. Our failures directly translate into a loss of health and, all too often, a loss of life.

It is not within the realm of reason to think that our profession is ever going to bat a thousand percent. Nevertheless, we all need to do our jobs to the best of our ability, since every percentage point below one thousand represents illness and even death, and a compromise of the goal our profession stands for.

Doing an okay job isn't good enough. Would you want a surgeon operating on you who thought that just doing an okay job was good enough? By the same token, would any right-thinking community deserve to have our profession (a profession that they pay for) do just an okay job in preventing threats to their health? I think not. Witness the criticisms of the response to the anthrax attacks or the U.S. Environmental Protection Agency's response to airborne health threats from the collapse of the twin towers; it is apparent that the community's answer is a passionate no.

Yet despite the obvious, we all know of far too many examples in which mediocrity is tolerated and even accepted. It is discouraging to see how deeply this tolerance for mediocrity has seeped into our work environments, work cultures, work ethics, and even work expectations. Fortunately, there are also stories of inspiration that can serve as a counter force to this disturbing trend. Such stories can be found right hem, within our own profession.

Take for example, the stirring story of how public health professionals quickly mobilized to figure out what was happening in New York when the West Nile virus suddenly appeared. Particularly striking within the story of the discovery of West Nile was the competence, determination, and intuition of the people involved. Had but a handful of professionals not stepped forward with their suspicions and hunches, efforts to control the mosquito population in New York would have lagged. Such a delay would have undoubtedly contributed to even greater levels of suffering and death in that large metropolitan area. The story of several people just doing their jobs to the best of their ability gives us all a push to remain excited about our work and to not accept anything less than the best.

The threats to health that we face today are almost mind-boggling.

We have the old foes, such as cancer, stroke, and heart disease, that continue to pile up huge numbers of casualties. In addition, we have new threats to health developing all the time, which range from newly resistant strains of old pathogens such as tuberculosis to such new and frightening pathogens as the SARS virus, E. coli 0157, West Nile virus, hantavirus, and invasive Group A strep (flesh-eating strep). We Have, thanks to the all-too-real specter of bioterrorism, the threat of purposeful releases of terrifying pathogens such as smallpox, tularemia, plague, anthrax, and Ebola. …

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