Health and Welfare

1. Health and Welfare

2. William James Mayo 1928 “The aim of medicine is to prevent disease and prolong life, the ideal of medicine is to eliminate the need of a physician. “

3. Plagues of the Past

4. The Influenza Pandemic of 1918 • The influenza pandemic of 1918-1919 killed more people than the Great War, known today as World War I (WWI), at somewhere between 20 and 40 million people. It has been cited as the most devastating epidemic in recorded world history. More people died of influenza in a single year than in four-years of the Black Death Bubonic Plague from 1347 to 1351. Known as "Spanish Flu" or "La Grippe" the influenza of 1918-1919 was a global disaster.

5. Camp Devens, Mass.Surgical Ward No 1629 September 1918 • These men start with what appears to be an ordinary attack of LaGrippe or Influenza, and when brought to the Hosp. they very rapidly develop the most viscous type of Pneumonia that has ever been seen. Two hours after admission they have the Mahogany spots over the cheek bones, and a few hours later you can begin to see the Cyanosis extending from their ears and spreading all over the face, until it is hard to distinguish the coloured men from the white.

6. It is only a matter of a few hours then until death comes, and it is simply a struggle for air until they suffocate. It is horrible. One can stand it to see one, two or twenty men die, but to see these poor devils dropping like flies sort of gets on your nerves. We have been averaging about 100 deaths per day, and still keeping it up. There is no doubt in my mind that there is a new mixed infection here, but what I dont know. My total time is taken up hunting Rales, rales dry or moist, sibilant or crepitant or any other of the hundred things that one may find in the chest, they all mean but one thing here -Pneumonia-and that means in about all cases death.

8. 1918 Spanish Flu I had a little bird, Its name was Enza. I opened the window, And in-flu-Enza.

11. Robert J. Blendon,* Lisa M. Koonin,† John M. Benson,* Martin S. Cetron,† William E. Pollard,† Elizabeth W. Mitchell,† Kathleen J. Weldon,* and Melissa J. Herrmann‡*Harvard School of Public Health, Boston, Massachusetts, USA; †Centers for Disease Control and Prevention, Atlanta, Georgia, USA; and ‡International Communications Research, Media, Pennsylvania, USA Vol. 14, No. 5 • May 2008 How familiar are you with the term “pandemic flu”? Do you know what this term means, have you heard of it, but are not sure what it means, or have you never heard of the term “pandemic flu” before?

12. What is Pandemic Flu? Pandemic flu is virulent human flu that causes a global outbreak, or pandemic, of serious illness. Because there is little natural immunity, the disease can spread easily from person to person. Currently, there is no pandemic flu. http://www.pandemicflu.gov/#

13. Robert J. Blendon,* Lisa M. Koonin,† John M. Benson,* Martin S. Cetron,† William E. Pollard,† Elizabeth W. Mitchell,† Kathleen J. Weldon,* and Melissa J. Herrmann‡*Harvard School of Public Health, Boston, Massachusetts, USA; †Centers for Disease Control and Prevention, Atlanta, Georgia, USA; and ‡International Communications Research, Media, Pennsylvania, USA Vol. 14, No. 5 • May 2008 Would stay at home for 7–10 days if public health officials recommended because you had flu You and all members of household would stay at home for 7–10 days if public health officials recommended because a member of household had flu

14. CDC Influenza Pandemic OPLAN11 January 2008 THE INFLUENZA PANDEMIC THREAT. 1) Influenza viruses have threatened the health of animal and human populations for centuries. Their genetic and antigenic diversities and their ability to change rapidly due to genetic re-assortment and mutations make it very difficult to develop a universal vaccine and highly effective antiviral drugs.

15. 2) A pandemic occurs when a novel strain of influenza virus emerges with the ability to infect and efficiently spread among humans. Because humans lack immunity to the new virus, a worldwide epidemic, or pandemic can result. Each of the three pandemics in the last century resulted in the infection of approximately 30 percent of the world population and the death of from 0. 2 percent to 2 percent of those infected.

16. POTENTIAL GLOBAL IMPACT OF PANDEMIC INFLUENZA (PI). 1) All nations face considerable challenges in mounting an unprecedented, coordinated global response to an influenza pandemic. Once a fully transmissible virus emerges, its global spread is considered inevitable. Countries might, through measures such as border closures and travel restrictions, delay arrival of the virus, but cannot stop it.

17. Pandemics of the previous century encircled the globe in 6 to 9 months, even when much of international travel was limited to ship or rail. Given the speed and volume of international air travel today, the virus could spread more rapidly, possibly reaching all continents in weeks or months.

18. POTENTIAL IMPACT ON THE UNITED STATES • 1) Despite annual vaccination programs and advanced medical technologies, an estimated 36,000 influenza deaths and 226,000 hospitalizations occur each year in the United States. Based on current models of disease transmission, a new pandemic could affect 30% of the U.S. population and result in the deaths of 200,000 to two million U. S. residents.

19. Flu Pandemic May Cost World Economy Up to $3 Trillion Dollars A flu pandemic could kill 71 million people worldwide and push the global economy into a ``major global recession'' costing more than $3 trillion, according to raised estimates by the World Bank of a worst-case scenario. By Jason Gale Oct. 17 (Bloomberg)

20. REPORT TO THE PRESIDENT ON U.S. PREPARATIONS FOR 2009 - H1N1 INFLUENZA Executive Office of the President President’s Council of Advisors on Science and Technology August 7, 2009

21. Total U.S. 2009 H1N1 Flu Hospitalizations and DeathsPosted August 21, 2009, 11:00 AM ETData reported to CDC by August 20, 2009, 10:00 AM ET

22. Possible Impacts of H1N1 produce infection of 30–50% of the U.S. population this fall and winter, with symptoms in approximately 20–40% of the population (60–120 million people), more than half of whom would seek medical attention.

23. lead to as many as 1.8 million U.S. hospital admissions during the epidemic, with up to 300,000 patients requiring care in intensive care units (ICUs). Importantly, these very ill patients could occupy 50–100 percent of all ICU beds in affected regions of the country at the peak of the epidemic and could place enormous stress on ICU units, which normally operate close to capacity.

24. cause between 30,000 and 90,000 deaths in the United States, concentrated among children and young adults. In contrast, the 30,000–40,000 annual deaths typically associated with seasonal flu in the United States occur mainly among people over 65. As a result, 2009-H1N1 would lead to many more years of life lost.

25. pose especially high risks for individuals with certain pre-existing conditions, including pregnant women and patients with neurological disorders or respiratory impairment, diabetes, or severe obesity and possibly for certain populations, such as Native Americans.

26. There is an important issue with respect to timing: The fall resurgence may well occur as early as September, with the beginning of the school term, and the peak infection may occur in mid-October. But significant availability of the 2009-H1N1 vaccine is currently projected to begin only in mid-October, with several additional weeks required until vaccinated individuals develop protective immunity.

27. Deaths-Leading Causes United States • Number of deaths for leading causes of death • Heart disease: 652,091 • Cancer: 559,312 • Stroke (cerebrovascular diseases): 143,579 • Chronic lower respiratory diseases:130,933 • Accidents (unintentional injuries): 117,809 • Diabetes: 75,119 • Alzheimer's disease: 71,599 • Influenza/Pneumonia: 63,001 • Nephritis, nephrotic syndrome, and nephrosis: 43,901 • Septicemia: 34,136 • Source: Deaths: Final Data for 2005, Table C

28. Poverty Sao Paolo, Brazil Slums are home to about 1 million people roughly twice the population of Seattle

29. World Bank Classification Low Income Economy $905.00 or less per capita

31. New Delhi India • Population 11,680,000 • 1,800,000 of which live in slums roughly three times the population of Seattle

32. World Bank Classification Lower Middle Income $906.00 - $3595.00 per capita

34. World Bank Classification Upper Middle Income $3596.00 - $11,115.00 per capita

36. World Bank Classification High Income $11,116.00 or more per capita

38. Science 15 March 2002:Vol. 295. no. 5562, pp. 2036 - 2039DOI: 10.1126/science.295.5562.2036Viewpoint Improving the Health of the Global Poor Prabhat Jha,1,2* Anne Mills,3 Kara Hanson,3Lilani Kumaranayake,3Lesong Conteh,3Christoph Kurowski,3 Son Nam Nguyen,2 Valeria Oliveira Cruz,3 Kent Ranson,3 Lara M. E. Vaz,1Shengchao Yu,4 Oliver Morton,5 Jeffrey D. Sachs6 The most obvious barrier to expanding coverage is the currently low level of expenditure on health. Average annual per capitaexpenditure on health is $26 (in 2002 US$) in countries under$1200 per capita GNP and all those in sub-Saharan Africa (16).

39. In the 48 poorest countries within this list, it is only $13.Moreover, only a minority of these expenditures come from publicbudgets. The rest are mainly paid out-of-pocket by the poor households,who spend more as a proportion of income on health care than doricher groups (17).

40. PUBLIC HEALTH:Enhanced: Cutting World Hunger in HalfPedro A. Sanchez [HN18] and M. S. Swaminathan[HN19]*Science 21 January 2005:Vol. 307. no. 5708, pp. 357 - 359DOI: 10.1126/science.1109057 • There are 854 million people in the world (about 14% of our population) who are chronically or acutely malnourished. [HN4] Most are in Asia, but sub-Saharan Africa is the only region where hunger prevalence is over 30%, and the absolute numbers of malnourished people are increasing (3). More than 90% are chronically malnourished [HN5] (4), with a constant or recurrent lack of access to sufficient quality and quantity of food, good health care, and adequate maternal caring practices

41. . Acute hunger [HN6] (the wasting and starvation resulting from famines, war, and natural disaster) represents 10% of the hungry yet receives most of the media coverage and attention. In addition, hidden hunger from micronutrient deficiencies [HN7] affects more than 2 billion people worldwide. Chronic and hidden hunger deserve much more global attention and support.

42. http://www.who.int/mediacentre/factsheets/fs310/en/index1.htmlhttp://www.who.int/mediacentre/factsheets/fs310/en/index1.html

43. Diseases 1) Cholera 2) Ebola 3) MRSA 4) Malaria 5) Typhoid Fever 6) Tuberculosis 7) Dengue Fever 8) West Nile Virus