Public Health
A victim of its own success

Quarantine…Do Not Enter,” said the bright placards that occasionally were seen on the front doors of houses when I was a little boy growing up in Dallas. Being quarantined didn’t carry any social stigma, it just meant that someone in that household had the misfortune of contracting a contagious disease. In the 1950s, polio swept through the community, even striking one of my classmates from Hyer Elementary School.

Before effective vaccines and antibiotics, isolating infected people from the rest of the community often was the only effective method of preventing widespread epidemics. We owed our very survival to the Public Health Department. If that sounds melodramatic, just remember that before the era of antibiotics, infectious disease was the No. 1 cause of death in this country and around the world.

As a sophomore medical student at UTMB in Galveston, my Physical Diagnosis class examined patients in the “TB Hospital”—the last remaining TB hospital in the state. By then, public health measures were so successful that the TB Hospital at Galveston was about to be closed.

Back then, by state law, every patient who was admitted to the hospital was tested for syphilis. Furthermore, state law mandated a VDRL for every couple applying for a marriage license. Public health research had demonstrated that if the disease were found and treated in the early stages, the infected person could be prevented from developing the terrible neurologic disorder of Tabes Dorsalis (tertiary syphilis), and its spread could be limited in the general population. Once again, public health measures were protecting society in general.

During the last 40 years, we have been blessed with the production of numerous vaccines. Because of these vaccines, smallpox was eradicated from the world (except for a few research labs), and polio almost has been eradicated. Measles epidemics now occur in this country only when vaccination rates fall too low.

As this golden period continued, the need for “public health,” with its quarantine placards and other measures, seemed progressively less important. In the yearly competition for distribution of tax dollars, Public Health seemed to have less and less justification for its existence. But when the AIDS epidemic arrived, it was Public Health employees who came up with ways to slow the spread of the epidemic—promoting “safe sex” and free condoms for gay men, and needle exchanges for IV drug abusers. These measures were not politically popular because some citizens saw AIDS as God’s judgment on the homosexual lifestyle and on drug abusers. (If AIDS had entered this country through the heterosexual mainstream, rather than through homosexuals, I suspect that society would have viewed the disease much differently.)

Public Health workers promoting free condoms and needle exchanges marked the death sentence for public health in this country. In Dallas, not only was the public health budget cut, but the City of Dallas closed its department, granting the County of Dallas authority over public health in the city limits. At the county level, the Public Health Department was buried under the overall structure of “Health and Human Services,” ie, the County Welfare Department. The county public health officer became a part-time position.

Why should we care if public health services have almost disappeared? Well, how about restaurant inspections? A few months ago, one of Dallas’ convention hotels was the site of the largest epidemic of salmonella poisoning ever recorded in the United States, affecting more than 3000 people and occurring during the time President Bush spoke there. These epidemics should be mostly preventable with adequate restaurant inspections. When they do occur, they should be promptly investigated, publicized, and stopped by public health measures. This particular epidemic went on for three weeks. Was your office notified that an epidemic was in progress? Did you hear about this on TV from our Department of Health and Human Services? I didn’t.
The attacks on the World Trade Center and the anthrax attacks that followed have made it clear that our lives have changed forever. The responsibility of recognizing and responding to future threats lies squarely on the shoulders of the public health system. The department we buried turns out to be critical to society’s survival, yet again! The DCMS Board of Health has been working on the issue of how to strengthen public health in Dallas County and surrounding areas. Our current system of each municipality having its own health department (and almost all of them being underfunded) leaves us without a unified regional plan to deal with bioterrorism. We need a strong, coordinated regional public health system to ensure our protection. This also might have the beneficial side effect of making it safe for conventioneers to eat at our hotels.

Copyright 1997-2002, Dallas County Medical Society.
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