13 Public Health and Human-Animal Medicine
Both the human and veterinary medical oaths address the need for the promotion of public health. This chapter deals with human-animal health situations in which population health duties take primacy and where human and veterinary clinicians perform many functions that place them together on the front line of public health practice (Color Plate 13-1).
In ancient Greece, Asclepius, Apollo’s son, was charged by the gods with caring for the mortals of Greece (the classic symbol of medicine is Asclepius’ staff, around which is wound one snake).* His two daughters were Hygeia (Figure 13-1), the guardian of health and champion of common sense practices as the basis of wellness (“cleanliness is next to godliness”), and Panacea, whose occupation was to cure individuals already sick, one at a time. Mortals remained healthier when they followed Hygeian principles, creating a healthy environment and preventing disease. Individuals who lost their health sought Panacea.
Figure 13-1 The bust of the Greek muse of health, Hygeia, on the CDC’s Roybal campus in Atlanta, Ga.
(From Centers for Disease Control and Prevention Public Health Image Library. Photo courtesy John P. Anderton.)
Although in today’s culture, human and veterinary clinicians are more likely to practice solely as the hand of Panacea, the “one health” concept—drawing human, veterinary, and population health practices together—is focused on providing a comprehensive approach to disease control and prevention and wellness promotion.
Key Points for Clinicians and Public Health Professionals
Public Health Professionals
Human Health Clinicians
Veterinary Clinicians
THE 10 ESSENTIAL PUBLIC HEALTH SERVICES
In 1994, the U.S. Public Health Service assembled and tasked the Public Health Functions Steering Committee to develop a working definition of public health and a guiding framework for the responsibilities of local public health systems.1 The resulting 10 Essential Public Health Services are the following:
The actions of public health professionals as well as human and veterinary clinicians that are mentioned in many sections of this book encompass these 10 core responsibilities.
DISEASE SURVEILLANCE AND INFORMATION FLOW BETWEEN HUMAN AND ANIMAL HEALTH PROFESSIONALS
Much of this book discusses the need for enhanced communication between animal health and human health professionals. Not always evident is the key role that public health professionals and the public health system play in such communication.
The first three core functions of public health systems are to monitor the status of the health of the community; to diagnose and investigate health problems and health hazards affecting communities; and inform, educate, and empower communities to improve health. To accomplish these functions, accurate information is required on the prevalence and incidence of disease events and risk factors as well as the extent of environmental health hazards. A major method of obtaining this information is from surveillance data gathered through mandated reporting systems. These data, reported by clinicians, laboratories, and others, are used to identify emerging diseases, plan for disasters, track trends, and evaluate progress of intervention strategies. Reportable disease events in animals could be sentinel events for human health hazards, and vice versa.
In the United States each state can set its own priorities for disease reporting. The Council of State and Territorial Epidemiologists (CSTE; http://www.cste.org) and National Association of State Public Health Veterinarians (NASPHV; http://www.nasphv.org) provide guidance for such reportable condition criteria and for both communicable and noncommunicable conditions. State and local health departments then provide selected data to the Centers for Disease Control and Prevention (CDC).2 Most states have required animal disease reporting of agricultural importance to agricultural agencies as well (see state requirements at http://www.biosecuritycenter.org/reportDisease.php). Box 13-1 lists the human infectious diseases that are nationally notifiable to the public health system. One animal disease, rabies, is also required to be reported. For a complete listing of nationally notifiable diseases and other conditions of public health importance (including injury and lead), see http://www.cdc.gov/ncphi/disss/nndss/phs/files/NNDSS_event_code_list_January_2008.doc.
BOX 13-1 Nationally Notifiable Infectious Diseases, United States, 2009
From Centers for Disease Control and Prevention: National notifiable infectious diseases. Available at http://www.cdc.gov/ncphi/disss/nndss/phs/infdis.htm. Accessed April 8, 2009. AIDS, Acquired immunodeficiency syndrome; HIV, human immunodeficiency virus.
Arboviral neuroinvasive and nonneuroinvasive diseases
Chlamydia trachomatis, genital infections
Haemophilus influenzae, invasive disease
Hemolytic uremic syndrome, postdiarrheal
Influenza-associated pediatric death
Novel influenza A virus infections
Poliovirus infection, nonparalytic
Severe acute respiratory syndrome–associated coronavirus (SARS-CoV) disease
Shiga toxin–producing Escherichia coli
Streptococcal disease, invasive, group A
Streptococcal toxic-shock syndrome
Streptococcus pneumoniae, drug resistant, invasive disease
Streptococcus pneumoniae, invasive disease, non–drug resistant, in children <5 years
Toxic-shock syndrome (other than streptococcal)
Vancomycin-intermediate Staphylococcus aureus
Vancomycin-resistant Staphylococcus aureus
In individual states, additional diseases may also be reportable to state health and/or agriculture departments.
In the United States veterinarians may be required to report selected clinical conditions to either public health authorities, who may perform further disease investigations to protect human health, or to their state veterinarian at the state department of agriculture for the protection of animal and human health. Ideally, the public health and agriculture authorities then communicate. State veterinarians provide selected data to the U.S. Department of Agriculture (USDA). Every 6 months the USDA reports to the World Organization for Animal Health (OIE) regarding the presence or absence of reportable animal diseases in the United States.3 Box 13-2 lists reportable diseases tracked by the OIE.
BOX 13-2 Animal Diseases Reportable to the World Organization for Animal Health
As of January 21, 2008. From World Organisation for Animal Health: OIE listed diseases. http://www.oie.int/eng/maladies/en_classification2008.htm?e1d7. Accessed March 3, 2008.
Multiple Species Diseases
Crimean Congo hemorrhagic fever
New world screwworm (Cochliomyia hominivorax)
Old world screwworm (Chrysomyia bezziana)
Cattle Diseases
Bovine genital campylobacteriosis
Bovine spongiform encephalopathy
Contagious bovine pleuropneumonia
Infectious bovine rhinotracheitis/infectious pustular vulvovaginitis
Malignant catarrhal fever (wildebeest only)
Sheep and Goat Diseases
Caprine arthritis/encephalitis
Contagious caprine pleuropneumonia
Enzootic abortion of ewes (ovine chlamydiosis)
Ovine epididymitis (Brucella ovis)
Salmonellosis (Salmonella abortus ovis)
Avian Diseases
Avian infectious laryngotracheitis
Avian mycoplasmosis (Mycoplasma gallisepticum)
Avian mycoplasmosis (Mycoplasma synoviae)
Highly pathogenic avian influenza and low-pathogenic avian influenza in poultry*
Infectious bursal disease (Gumboro disease)
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