100 YEARS AGO
Health Insurance
[H]ealth insurance is another step in the process of bringing to pass a condition wherein society shall bear, distributively and immediately, the loss which must ultimately fall upon it. It is another step in the socializing process which is going on in America as surely as the years themselves. . . . Social legislation has always had to fight its way very slowly, partly because of its neglect or inability to make clear the economic waste of permitting social wrong to continue. The business man will believe firmly enough in his workers’ health when he is convinced that it is identical with the interest of his business.
From AJPH, April 1916
50 YEARS AGO
Recent Federal Legislation: Its Meaning for Public Health
One does not hear that old myth so much anymore, about the good medical care in this country being available to the very rich and the very poor. It has become too obvious that many of the benefits of modern medical care are not reaching the poor. With the possible exception of highly specialized treatment for complicated and serious conditions, the poor are getting poor medical care. This nation has never really committed itself to a course of action that would make the best of modern medicine equally accessible to all—young and old, black and white, rich and poor.
From AJPH, April 1966
Even before the World Health Organization (WHO) declared the epidemic of microcephaly a “Public Health Emergency of International Concern,” the interest by public and media was clear. The series of articles in this April issue of AJPH explores aspects of this—in some ways unprecedented—public health situation: the first almost-but-not-quite pandemic to cause congenital malformations. Curiously, scientists and international organizations are taking public health actions and giving advice assuming that the epidemic of microcephaly is caused by congenital Zika infection, while remaining reluctant to accept the causal link. And almost every day comes with its new first: the first congenital transmission of a vector-borne virus in humans and possibly the first sexual transmission of a vector-borne virus.
Zika has been known for 50 years, but until recently it has had limited public health importance. The scientific community was unprepared for the size and speed of the epidemic, the congenital transmission, and the severity of neurologic abnormalities. The articles in this series summarize the sparse published evidence on Zika, describe the course of the epidemic, and examine the reaction from the public health sector (from reporting of the disease to provision of early stimulation for affected children, the arguments for causality, and the first efforts to define the congenital Zika syndrome). Zika is transmitted by Aedes, which is very resilient to control measures; it thrives in large densely populated cities with inadequate environmental conditions. Like Zika, Aedes has been known for a long time, but unlike Zika, it has a long history in public health and has been linked to efforts of eradication of yellow fever and dengue. Here, we examine the history of victories and defeats in the battles and wars against this vector.
More than 4000 suspected cases of microcephaly were reported in the Brazilian epidemic (numbers will be revised down as they are investigated). The speed from the first noticeable increases in microcephaly to implementation of surveillance and control measures in Brazil, alert by the Pan American Health Organization, and declaration of a Public Health Emergency of International Concern by WHO was impressive, but so was the geographical expansion of Zika, from Brazil to the rest of Latin America in a few weeks; it may still spread to the remaining countries where Aedes is present. The articles in this series present an assessment of the threat in the Americas. Countries not at risk for Zika transmission have advised pregnant women not to travel to affected areas. Women from affected areas have been advised to protect themselves from mosquito bites if pregnant and consider avoiding pregnancy if not. Of course, not all women have sufficient control over their lives to avoid pregnancy. In the outbreak in French Polynesia before the Brazilian one, the spike in microcephaly was not detected at the time because the majority of women with affected fetuses chose to have a termination. In many countries in Latin America, there is no legal abortion; the debate on the right of women to choose how to proceed with their pregnancy has reopened in Brazil.
What can we expect in the future? How will this story develop? We do not know if Zika infection offers substantive, lasting immunity. The best scenario, until an effective vaccine is developed, is that after these explosive outbreaks, most people will be immune and Zika will become a childhood disease while international scientific cooperation will lead to the fast development of effective affordable tests, a vaccine, safe treatment, and better tools to control Aedes. Even the worst tragedies can bring small opportunities. Maybe two of the legacies of this Public Health Emergency of International Concern will be a better recognition of the need for support for disabled children and the reopening of the debate for a legal right for women to choose the course of their pregnancy in Latin America.