April 2010

Changing generations in public health.

mother...

In the 1970s, public health was not in the spotlight. Vaccinations had brought smallpox, polio, and many other diseases under control, and while tuberculosis and sexually transmitted diseases were still issues, the general population did not feel particularly vulnerable.

daughter...

I work in an era where public interest in health issues is very strong. I was in graduate school on September 11, 2001 and when the anthrax attacks occurred. Bioterrorism preparedness, the area I was researching, was thrust into public health. Today, diseases such as H1N1 influenza and West Nile virus are in the news regularly. Consequently, the public has a greater interest in diseases, and, hopefully, a better understanding of risks and prevention.

Jill Marsden, consultant, health policy and planning
Nicola Marsden-Haug, Epidemiologist, Zoonotic Diseases, Washington State Department of Health

Our public health careers span more than 40 years. Looking back, one of the most striking differences between our experiences is the level of community awareness of public health issues.

Jill Marsden

I first became involved with health issues when I emigrated to the US in 1966 and worked on surveys of migrant farm workers. I had read The Grapes of Wrath but never expected to find those conditions in the state of Washington in the late 1960s. The lack of access to health care and the exposure to environmental hazards appalled me and led me to work in the community clinic movement, and then into public health.

When Nicola was born, I was managing the King County Emergency Medical Services (EMS) Division. This was a new venture in King County and policy makers questioned whether it was an appropriate role for public health. However, area residents were supportive and eagerly anticipated the expansion of paramedic services to their region. In the 1970s, EMS helped give public health visibility, but by and large the field was not in the spotlight. Vaccinations had brought smallpox, polio, and many other diseases under control, and while tuberculosis and sexually transmitted diseases were still issues, the general population did not feel particularly vulnerable.

I was concerned about access to health care for the uninsured and low income. I wanted to see public health take a leadership role in advocacy, planning, and mobilization of resources to increase access to care for these populations. Many in local government believed that this was a state or federal concern and not the business of local public health. After all, national health insurance was just around the corner in the mid 1970s.

Communicable disease remained largely out of the public eye until the 1980s. Immigration from Southeast Asia in the late 1970s brought federal funding for refugee screening programs and a greater focus on TB and communicable disease, but it was the recognition of AIDS in the 1980s that finally put public health in the spotlight.

Nicola Marsden-Haug

By the time I was in elementary school, HIV/ AIDS education was already being taught in classes. I recall growing up watching movies such as Outbreak, reading science fiction about genetics, and following news about E. coli O157:H7 linked to hamburgers at Jack in the Box. Public health, while not necessarily named as such in the media, was ever present in the public eye. To me, my mom’s work in administration and policy was important, but wasn’t nearly as exciting as the fast-paced, volatile world of infectious disease. I entered public health with the intention of working in outbreak investigation.

I was in graduate school and working at Walter Reed Army Institute of Research on September 11, 2001, and when the anthrax attacks occurred. Bioterrorism preparedness, the area I was researching, was thrust into public health and caused an increased sense of vulnerability to communicable disease among the public. In 2003, people learned just how quickly diseases could spread while watching worldwide media coverage of Severe Acute Respiratory Syndrome (SARS) in China and Toronto. More recently, national foodborne outbreaks and recalls, such as peanut butter and tomatoes, have brought attention to food safety.

I work in an era where public interest in health issues is very strong. High profile organizations such as the Gates Foundation and PATH increase public awareness of these issues. Today, diseases such as pandemic H1N1 influenza and West Nile virus are in the news regularly. Consequently, the general public has a greater interest in diseases and, hopefully, a better understanding of risks and prevention.

Both

Over the years, some issues have found themselves back in the spotlight, such as access to healthcare and insurance. Public health awareness has greatly increased during our careers, but funding for public health remains a product of federal policy. Money tends to follow the latest, most highly publicized “disease of the moment,” leaving public health to scramble for adequate state and local revenue sources to maintain basic services.

then & now, a monthly e-postcard, is part of NWCPHP's celebration of 20 years of promoting excellence in public health practice and is the recipient of a 2010 APEX Award for Publication Excellence. If you would like to receive these monthly e-postcards, or have a story idea, please email us at nwcphp@u.washington.edu.