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Let’s talk about public health. It’s one of those boring infrastructure things people don’t talk about very often and of which the general public is only fleetingly aware. It’s what I do, and it’s essential to a fluid, functioning economy. It’s also losing funding left and right, because the people most frequently served in public health settings are poor folks who rarely have health care anywhere else.

Public health is an important supporting component of a world-class economy. Without it, people have shorter, less healthy lifespans, and less of that lifespan is spent as productive members of the workforce. People have more and more expensive health conditions, and pass them on to younger generations, who either aren’t as functional or are too frequently ill themselves to focus on schooling. Because of ill relatives and parents, households are poorer, and children are often required to enter the workforce at younger ages just to support family. And because family planning services are often part of the public health picture, they start families at younger ages, too – leading to lower education levels for the population as a whole, especially women (and the most developed economies in the world all have highly educated women in their workforces). Essentially, goods and services don’t get produced and delivered when the population is sick, disabled, or dead.

Following are some examples of what public health workers do to prevent people from getting so sick they can’t work and can’t live well.

Clean water is a public health responsibility. Say a water-borne disease crops up – let’s use cryptosporidiosis as an example. Crypto causes frequent and debilitating diarrhea for weeks in many healthy individuals and can lead to death in people with less than competent immune systems (children, the elderly, people living with AIDS or diabetes, as examples). If it is diagnosed and reported, that triggers a public health investigation. Public health workers talk to people who have been diagnosed and, through interviews and investigation, find out where they might have gotten the disease and who else may be exposed and need treatment. That way, the public can be alerted so they can take preventive measures (like avoiding a contaminated body of water) or seek treatment if they have symptoms.

Insect and animal borne disease are public health responsibilities. When a friend of mine was bitten by a raccoon a few years ago, he began preventive measures for rabies at his local emergency room, but the rabies vaccination series goes on for several weeks and is expensive. However, rabies is not curable or treatable: almost all people who develop rabies die. Fortunately, public health workers at his city health department administered the vaccine for him and he was not charged for their services; the state provided the vaccine at reduced cost so that he would not die of rabies. Even better, the local city health department’s animal control staff contacted him shortly after the bite was reported to determine where and when he was bitten, and if they could locate the animal for extermination and testing so as to avoid further danger to the public.

Whenever you hear of a case of West Nile virus, that’s your public health staff at work, too. In many places where foreclosures are at exceptional levels (for example, Florida or Nevada), many pools go unattended, uncleaned, and unchlorinated. They become what are called “green pools”, and they become breeding grounds for mosquitoes. Public environmental health workers respond to reports from the public and help keep those bodies of water from breeding mosquitoes which may carry disease like encephalitis viruses or West Nile. And should those diseases appear, they investigate to find the source and eliminate it if possible.

Speaking of environmental health, these public health workers also make it safer for you to eat anywhere you choose. Many of us have had moments when we ate somewhere and later experienced illness. We can report that to our local health department, and environmental health workers investigate. They also conduct regular inspections with not only food service locations, but also in many places with places like tattoo parlors and piercing salons – to make sure proper food service and storage practices and proper sanitation practices are followed. In many places, they grade restaurants on their compliance with required sanitation and food-handling practices – that “A” you see posted by a restaurant is your public health staff at work making sure you know it’s probably pretty safe to go out to eat. This way, you can worry more about if there was mustard or mayo on your burger, and less about whether or not you’re going to get salmonella from it.

That said, when there ARE outbreaks of food-borne disease, your public health workers are on it. They conduct an investigation and make sure that if there were unsanitary practices involved, those practices are corrected. Or, if the source was agricultural, it is identified, the public notified of the risks, and product recalled when necessary to avoid health repercussions. Remember that huge spinach recall a year or two ago? Public health workers, including agricultural inspectors did their jobs.

Immunizations are also part of this picture. Here in southern Nevada, if you want to work in a job in which you handle foods, because a common waterborne and food-borne illness is hepatitis A, you are required to be immunized for the infection so that it cannot be passed on to customers via your work. Additionally, many other immunizations – for pneumonia, HPV, shingles/chicken pox, measles, mumps, rubella, diphtheria, tetanus, hepatitis B virus, and many others – are offered to the public, especially children, at reduced or no cost. Though many people take issue with immunization, many others do not; as a result, the vast majority of the population is not ill or suffering chronic effects from vaccine-preventable disease, and cannot contract or pass on the disease if exposed.

Your public health workers also prevent sexually transmitted diseases, like gonorrhea, Chlamydia, syphilis, and HIV from badly affecting large portions of the population. Connected to these services, many public health workers also provide family planning and preventive health services to women and their partners to prevent unwanted pregnancy and help people have healthy babies. They provide testing at reduced cost to the general population, and often reduced or no cost to those at most risk. They link people to treatment and care services, and make sure medications reach those who most need them. Did you know Chlamydia-caused pelvic inflammatory disease is a common factor in infertility – and that Chlamydia is the most common reportable infection in the USA? The role these workers play in making sure young people receive education, testing, and treatment helps young women and men avoid infertility – so they can go on to start families (and produce more workers for the next generation). The same public health workers also provide enhanced services to pregnant women. These workers pushed for laws requiring opt-out testing for HIV and syphilis for women in prenatal care, and they follow the progress of those who are diagnosed during pregnancy to help assure that babies are not born with Chlamydia, gonorrhea, syphilis, or HIV. These same public health workers also find out from the infected who else may have been exposed, and locate those at risk to offer testing, treatment, and referrals for services. Your public health workers also conduct these same kinds of investigations for tuberculosis, and commit to meet with infected members of the public repeatedly for several months to make sure they take medication that cures their tuberculosis and helps them avoid infecting other people.

Public health workers also help people access substance abuse treatment to improve health outcomes – and there’s another whole sector of public health workers who help make sure those treatment services aren’t available only to the well-heeled. Further, where it is legal (sadly, not everywhere), public health workers also participate in needle exchange to help those who are not yet ready to leave substance use behind avoid contracting HIV and hepatitis viruses from needle sharing. Needle exchanges also provide opportunities for injection drug users to get referrals to substance abuse treatment when they’re ready, and to get care for wounds and infections. In many places where it is not legal, many local law enforcement departments can make agreements to allow these services to occur, but not all do, and not all officers agree. Many times, public health workers perform needle exchange anyway and risk arrest to help protect the public health (I did; it’s worth it).

Like those who perform needle exchange, many public health workers risk their well-being to do their jobs – animal control workers sometimes face dangerous animals or insects. Restaurant inspectors may be threatened by business owners who see health inspectors as threats to their livelihoods. Public health outreach workers go wherever people may be, when they need to be there to reach them – and some of those locations aren’t in the safest of places.

If the above feels exhausting to read, perhaps it’s my writing…or perhaps it’s because it’s long. This doesn’t even cover ALL the many things that public health workers do for their communities. I didn’t cover refugee health. I didn’t cover public health emergency preparedness (hurricane? earthquake? We’re on the front line helping survivors, even if we’re victims too). I didn’t mention so many other things. But we are legion and we are varied and, so often, we are anonymous and unseen.

Imagine the state and country you know without these services. No restaurant inspection. No immunizations. No HIV prevention. No tuberculosis prevention. No insect or animal control. No clean water or agricultural inspection. Imagine how much harder it would be to staff ANY business, or for people to feel relaxed and healthy and ready to work, when the population is trying to deal with waterborne disease, food-borne disease, sexually transmitted infections like HIV and syphilis, tuberculosis, and vaccine-preventable illnesses. How many of those people would die? How many would be disabled and unable to work? How many would only be able to work some of the time?

People here in the United States are often stunned that public health workers like me exist. There’s a reason for that. By and large, we do an excellent job on a pittance. People often think disease like syphilis and TB are things of the past because we help keep them from spreading widely.  Funding for what we do is so often flat at best, often declining (even as the cost of living, doing business, and offering health services goes up). What worries me is that people have frequently become so accustomed to a lifestyle to which so much of the world would like to become accustomed that they have grown to feel entitled to it. Business leaders and people at large feel entitled to a relatively healthy, low-disease workforce and lifestyle. At the same time, they don’t want to pay the taxes that have created this environment that has made it easier for them to succeed. That’s “entitlement reform” I’d like to see.

Originally posted to ElsieElsie on Mon Jul 09, 2012 at 11:02 AM PDT.

Also republished by Community Spotlight.

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