This is a very short opinion piece because I don’t think it need must explanation. I want you to think the recent events in Dallas regarding the transmission of Ebola on to American soil. I see it as a big wake up call to all Americans, but specifically to affluent America. Why do I say that? For the vast majority of the 20th century our medical care system was based on a public health model or what I refer to as an infectious disease model. Your health was as much a concern to me as my health and the health of my family and those close to me. I did not have to like you or was totally against you living next to me or marrying daughter, but I had to be sure you were immunized or at least programs in place for the diseases you might transmit to me. When the vaccines for polio or influenza or other highly contagious diseases were developed, you did not have to worry about whether it reached the poor or not. It was to my benefit that it did.
When we turned our attention to chronic diseases and the world became more about me than we, public health ended up on the back burner. And with that, the disparities that didn’t exist start, and those that were already there became exacerbated. We ended the world of discoveries as oppose to discover and delivery. And as Harold Freeman stated to preach, the gap between discovery and deliver is getting wider and wider. We began to look for the magic bullet to cure a disease as oppose to looking at preventing diseases.
Although disparities have existed with some chronic diseases, the large gaps of today is a recent phenomenal. Let me provide you with one example of a chronic disease, breast cancer. As we are in the month of October and Breast Cancer Awareness Month and the gap between African American women and white women is so well know, has it always been the case. Looking at the cities of Chicago and Houston, Dr. Steve Whitman and his associates provide data that there were no different in breast cancer mortality rates between African American women compared to white women in the 90’s. Looking at post 2000, the different going from 32.8/100,000 to 40.80/100,000 deaths for African American women and 41.3/100,000 to 28.2/100,000 deaths for white women in Houston. In Chicago, the different going from 38.10/100,000 to 41.40/100,000 deaths for African American women and 37.40/100,000 to 19.2/100,000 deaths for white women. Why such drastic reductions in one group and not another? One can do this with a number of chronic diseases in terms of health inequities. Can we say that the gap between discover and delivery is widening for one specific group? It is not that you have a bias, we all having biases. It is what you do with that bias.
When we turned to a chronic disease model, we lost that human connection and our prejudices started to surface and with it the issue of health inequities. Health inequities is a problem for us all. But let’s approach it from a health disparities and infectious disease standpoint. We know that low income, uninsured people often forego or delay care for a number of reasons while trying to carry on with their lives — taking care of their kids, going to work, etc. These folks may not even be aware of an Ebola risk and just assume if they keep moving, they will eventually get better like always. And then you also have people who may or may not know about the risk but will not seek help because they fear coming in contact with authorities in the U.S. This is much more problematic than many people realize and has the potential to be greatly exacerbated by US health system policies that have historically and systematically left people out. This is where the chronic disease model comes in versus the infectious disease one. Now think about such will have on our well being as a nation. If we continue to think of it as their problem as oppose to ours. With a recent gallop poll indicating that two out of three white Americans think that health inequities is not a major issue that needs to be addressed; with perception that such is being taking care of by the Affordable Care Act, the reality is that we are one person away from a major pandemic. Not realizing that in an infectious disease model, these invisible people’s health is critical to my health, whether I have a bias or not. The critical factor is that in an infectious disease model one can trace the threat directly to me. I do not know when or where I will come in contact with that infected person and therefore I have to be sure that he/she has to be treated for either getting the disease or care for with the disease. Now think about how we view chronic diseases. It is there problem and not mind, primarily because I don’t see it as a threat my well-being, when it really is. So if it would thought in an infectious disease frame of mind, do you think heath inequities would exist as they do today?