July 12, 2020
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10 Greatest Public Health Concerns in U.S. Cities

10 Public Health Issues Facing American Cities

The mitigation of public health issues is one of the biggest concerns for those whose career path leads them to healthcare management. This holds particularly true for those who work in public health in busy urban areas. Due to population sizes, the unique challenges of transportation, and other contributing factors, these public health challenges tend to be proportionally larger than they would be in smaller areas. In light of this, it’s important to know what these public health challenges are if you’re planning on a career in the field. Here’s a list of 10 of the most pressing issues of public health facing cities and public health administrators today.

1. Poverty

To some extent, this factor touches many of the major problems that stress the healthcare facilities in the major urban centers across the United States. Populations that live in extreme to moderate poverty tend to have limited access to any adequate health care. In turn, this leads to preventable diseases spreading as they would not in more affluent areas. Additionally, it raises the mortality rate for these diseases as well as conditions associated with poor nutrition and unmonitored pregnancies. Individuals who live in these circumstances are also often less well-informed about sexually transmitted infections and their treatments, have limited access to primary nutrients, and live in more densely populated housing conditions.

2. Contamination of Water Sources

While this is a broader issue that incorporates considerations of urban infrastructure, climate change, and enforcement of laws designed to reduce illegal dumping, individuals who manage or work within the health care system will face it directly. The damage of lead piping and water mains is far from isolated. It’s estimated that more than 5,300 municipal water systems in the United States still use lead pipes. No amount of lead in the human bloodstream is safe. Add to these airborne pollutants, direct contamination of water sources via illegal dumping or landfill leaching, and America’s urban public may face a significant suite of health issues in the future. This includes brain damage in both adults and children, developmental delays or shortfalls in children, cancer of every variety, but especially of the gastrointestinal tract, and other debilitating diseases.

3. Anti-Vaxxers, Communicable Disease, and Education

Individuals who work with the public to provide both effective health care and education about public health concerns deal with the complications of urban communicable disease spread. In any situation in which many people live in close quarters, conditions are apt to spread. Those with animal vectors, such as Zika, West Nile, or Lyme disease, were once constrained by geography and climate. This is changing, and vector species are expanding into new territory. Other bacterial or viral infections once thought all but eradicated are gaining footholds in urban environments once more. The resistance to vaccination by some poses a threat to all, especially very young children. Coupled with this movement is an increasing resistance of bacteria to antibiotics, fed by years of excessive prescription and the public habit of not finishing their antibiotics courses.

4. Epidemics and Pandemics, Infectious Diseases

If there’s one thing that the Coronavirus has demonstrated, it’s that larger populations are severely affected by runaway viruses and other infectious diseases. This situation also shows how quickly infectious diseases bring cities to their knees. Until COVID-19 hit, the devastation of diseases, like the 1918 Spanish flu outbreak, was just something that happened in history books. It’s easy to forget that humanity’s advancements in technology, travel, and medicine may still not be a match for a tiny unknown bug.

The truth is the Spanish flu killed nearly 700,000 people in the US and up to 50 million people worldwide. Bigger cities, like Philadelphia, New York, and Boston, saw the worst of it. Philadelphia, in particular, stands out because the spread of the Spanish flu was caused in large part by the Liberty Loan Parade, which was allowed to take place despite the growing threat of the disease. About 200,000 people attended that event, and predictably, the flu burned through that city like a match in a tinderbox by the fall of that year.

Today, COVID-19 is wreaking similar havoc in New York and has shut down numerous countries, including Italy. Scientists now know that social distancing is imperative, as is early testing until a vaccine can be created. It is difficult to say how many people in the US will die of COVID-19. Estimates range from 40,000 to 200,000 or more. Certainly, how public officials deal with this crisis will determine the final numbers of those who get sick with the disease.

5. Alcoholism and Related Health Complications

One might think of the consequences of excessive alcohol consumption in the immediate sense, but there are other far-reaching concerns. The CDC reports that binge drinking is associated with liver disease, increased potential for injury, and many other systemic diseases and cancers. But it also presents an indirect health crisis for cities beyond the years of life lost or the cost of repairs and health care to the drinker. It can also increase the potential for violent crime and domestic abuse. These factors directly impact healthcare professionals working with urban populations.

6. Inadequate Nutrition, Obesity, and Food Deserts

Another complex issue facing city managers in the US is the obesity epidemic and the factors that cause it. Food deserts are a phenomenon unique to this country, the only developed nation to contain them. Populations must travel several miles to obtain fresh food, often to their detriment regarding time and cost. What replaces grocery stores or markets compounds the health issues this presents—food vendors that peddle nutritionally void substances laden in fat, salt, and sugar. Obesity is a symptom with symptoms of its own and its presence in underserved, impoverished urban communities has grown and spread beyond demographic boundaries. Add to this type-2 diabetes, neurological and psychological complications, and a host of diseases reliant upon context, and you can see the problem quite clearly.

The close context of urban environments often compounds the complications medical professionals face. Managing systems that provide care for populations in American cities is a complex undertaking that must account for the underserved as well as those with ample access to health services and assess the needs of distinct communities. As a part of that, the greatest urban health care concerns must be taken into account when designing or implementing the systems through which care is administered.

7. Climate Change

Many people view climate change as something that causes the polar ice caps to melt and the seas to rise. While this is true, the effects of these changes also set in motion a tidal wave of public health challenges, including pandemics, cardiovascular disease, poverty, cancer, and depression. For example, the polluted air, which contributes to climate change, may also cause those with asthma and heart disease to have more severe and disruptive consequences when the weather turns extremely hot or extremely cold.

Food and water shortages can arise when changing temperatures decrease the water supply, which in turn, can decrease crop production. On the flip side, floodwaters can deluge crops, destroying them in a matter of days.

As for seeing an increase in infectious diseases, many diseases, like malaria, West Nile virus, and Lyme disease proliferate when certain climatic conditions exist, according to an article on the Columbia University website.

Given how issues like COVID-19 have devastated many parts of the world, it’s a good lesson to pay attention to.

8. Trauma

Epimonitor.net calls trauma the number one public health challenge of the century. Trauma can arise from a number of sources, including child abuse, domestic violence, natural disasters, war, rape, terrorism, the death of a loved one, or divorce. Even something good, like moving to a different location due to a job offer, can cause trauma.

Unfortunately, left unchecked, PTSD (post-traumatic stress disorder) can develop from traumatic incidences, particularly if the trauma is repeated trauma, like child abuse or domestic violence. When trauma gets to this point, it changes the body’s chemistry and hormonal flow, leaving the person in a constant state of distress.

These, as well as the PTSD-induced changes to the brain, have long-term effects on a person’s physical, mental, and emotional health. It isn’t unusual for traumatized people to develop chronic physical and mental health problems, like heart disease, diabetes, depression, and more.

9. Coronary Artery Disease, High Cholesterol, and Hypertension

According to USA Today, several of the most pressing public health challenges revolve around the circulatory system. Hypertension accounts for 12.5 percent of the public health challenges, while coronary artery disease stands at 7 percent and high cholesterol at 8.6 percent. Left unchecked, these issues can cause strokes, heart attacks, diabetes, and high blood pressure. These seemingly separate issues work in tandem to wreak havoc on people’s health.

High cholesterol and coronary artery disease contribute to high blood pressure, a condition that causes the blood to create undue pressure on the arteries. Other public health issues, like obesity, poverty, and trauma have also been shown to have a correlation to this trio of issues. For some individuals, these issues if left unchecked lead to a significant decline in health and even death.

10. Gun Violence

Gun violence in the US contributes to countless injuries and deaths each year. Currently, 88 people die each day due to gun violence. For every gun that gets used in self-defense, there are seven murders or criminal assaults, 11 suicide attempts, and four accidental shootings. Unfortunately, these stats mean that the US has one of the greatest homicide rates in the world, many of which are caused by gun violence.

More complications arise for medical professionals and public health administrators in large urban areas than they do in less populated areas. These professionals must figure out how to make public health services available to the people of the city. Unfortunately, as issues, like COVID-19 show, public health challenges can quickly take down a city’s public health system in a matter of weeks if not days. This is the primary argument for health and disaster preparedness. Good preparation has the power to mitigate the effects of these public health issues almost faster than any other solution can.

Additional Sources:
1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1891652/
2. http://www.watereducation.org/aquafornia-news/5300-us-water-systems-are-violation-lead-rules
3. https://www.apha.org/topics-and-issues/communicable-disease