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January
2003
Ship Happens
The president's
plan to vaccinate 1 million soldiers, health care workers and law
enforcement officials against smallpox illuminates often-overlooked
aspects of public health.
Last month's
small-scale public health crisis, an outbreak of serial diarrhea
and vomiting aboard several prominent cruise liners, might serve
as a relatively benign model of how to react when the threat is
much higher. This event brought home to about 1,500 vacationers
a sharp reminder about the link between cleanliness and health.
But it also underscored the interplay of industry and government
and, more important, that knowledge about disease has little value
if we don't implement policies based on it.
A new study
of nearly 2,300 inspections of 270 cruise ships between 1990 and
2000 found, not surprisingly, that when government inspectors got
together to work with cruise ship owners, they reduced the incidence
of ship-borne illness by 44 percent. They also found a direct relationship
between a ship's cleanliness score and the rate at which its passengers
turned green.
There is no
cure for what is commonly (but inaccuratley) called "stomach
flu." But there are actions that can ward off future outbreaks.
Some are individual responsibilities (washing hands), some are corporate
responsibilities (being careful with food) and some are public responsibilities
(inspecting the ships' sanitary practices and making that information
publicly available).
And, in fact,
the ships that suffered the negative publicity had excellent records.
How do we know? Because since 1975, the U.S. government has required
unannounced inspections of every ship docking at American ports.
Since 1998, the results of those inspections have been posted on
the Web site of the Centers
for Disease Control and Prevention.
The cruise
ship incidents highlight three important things about public health
that we should keep in mind when preparing for bioterrorism:
- First,
even when all parties responsible for dealing with a public health
crisis are doing what they are supposed to, bad things still happen.
- Second,
the news media play a critical role in responding to a public
health crisis. In this case they disseminated accurate, science-based
information and gave the public access to data that were otherwise
tucked away on an obscure government Web site, available only
to those who have a computer, recognize a risk and know where
to look.
- Third, the
government is responsible for public health. But it needs the
cooperation of those it regulates and the public to report outbreaks
of illness and do the right thing to contain them. Once we know
about something and can count it, solutions are that much easier
to come by.
The government's
ability to collect information about health threats and patterns
of illness and to direct industry and the public toward a solution
is the core of our public health infrastructure. It must be supported
and improved if we are to be safe from bioterrorism.
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