The Year in Preview, Part One
There is no crystal ball in public health. Many of the coming year’s challenges will arrive unannounced, whether an infectious disease outbreak or social issue that demands a population health perspective. At the same time, much in public health will likely remain a constant: not least of all, deeply rooted health disparities and chronic diseases—although whether and how new policies and interventions can alleviate these problems remains to be seen.
To gather intelligence on some of the public health issues we might face in the next 12 months, Transmission spoke with nine Mailman School faculty about everything from the 2016 presidential election and the Summer Olympics to gun violence and climate change. Read their predictions in the next three issues of the newsletter.
Playing Politics With Health
After the 2012 Presidential Election and two major Supreme Court cases, the Affordable Care Act appears to be here to stay. Even so, the 2016 Election could have big implications for how the government implements the law. Already, candidates are discussing the merits of the taxes designed to help pay for the ACA and Congress has taken action, delaying the so-called Cadillac tax on large private employer healthcare plans and pausing the medical devices tax—a move that leaves the financing for the 2010 healthcare law in jeopardy. At the state level, decisions about the expansion of Medicaid coverage are on the ballot, as many Republican governors and state legislatures have opted against expanding Medicaid, limiting the reach of the ACA in the process.
While healthcare likely won’t be the number-one issue in the lead up to the election in November, campaign rhetoric around the ACA is expected to be fierce. It’s part of a broader debate between the two parties around the role and size of the federal government. “Republicans will argue that philosophically and pragmatically, the government has gotten too big, too invasive, and it needs to be scaled back, and healthcare is part of that,” says Michael Sparer, professor and chair of Health Policy and Management. “On the other side, Democrats will frame the issue around the claim that healthcare is a market that the government should play a role in and that ACA is the best example of major government initiative to ensure that people have coverage and access to good, quality care.”
Olympic-Sized Health Risks
Come August, all eyes will be on Rio de Janeiro as the city hosts the 2016 Summer Olympic Games. Yet with only months until opening ceremonies, there are many unanswered questions about whether the Games will take place in safe and orderly fashion. One high-profile concern is the safety of waterways planned for rowing and sailing events as recent tests confirmed widespread sewage contamination that could threaten athletes’ health. Another worry is whether or not the Rio’s infrastructure is ready for a massive influx of spectators. While the city made huge investments in Olympic facilities, streets and electrical lines remain in serious disrepair.
In Rio earlier this year, Gina Lovasi, assistant professor of Epidemiology, collected data on the infrastructure of Rio das Pedras, home to over 63,000 people and the city’s third largest informal community or favela. Sponsored by Medtronic Philanthropy, the project put researchers on the street with smartphones and tablets to survey residents with the goal of finding ways to protect their health. More recently, Lovasi, the co-director of Mailman’s Urban Health Initiative, took part in a Rio-focused Columbia Design Challenge organized by Columbia Engineering. Her project tasked students with coming up with solutions to the city’s water woes. Finalists of the Columbia Rio Challenge will be announced in March.
“The global spotlight that the Olympics represents gives us a unique moment to advocate for investment in health in this area [of Rio],” says Lovasi. “It's an exciting time to make sure that the energy and the resources around the Games are leveraged to benefit the health of the population and its long-term health goals.”
Emerging Infectious Threat
An authority on emerging infectious diseases, Epidemiology Professor Stephen Morse has been following the spread of the mosquito-borne Zika virus in Latin America. Thought to have been introduced by visitors to the World Cup in 2014, Zika is latest disease to jump to the West Hemisphere, closely following Chikungunya, also spread by mosquitos. So far, the virus has spread to nine other countries and, most recently, Puerto Rico.
Normally Zika leads to mild disease, but alarming recent reports have linked the virus with microcephaly—a birth defect resulting in a small head and greatly reduced brain size. The U.S. Centers for Disease Control and Prevention urges those traveling to the affected countries—especially pregnant women—to safeguard themselves against mosquito bites. Going further, officials in Brazil are warning women to think carefully about getting pregnant. “They’re trying to be cautious until this gets sorted out,” says Morse. “The chances of this happening to any particular mother and newborn are small, but if it happens to you, it’s tragic. So it’s prudent to be careful.”
Given the absence of effective mosquito control programs in most places, Morse predicts we’ll see cases of the infection well into 2016, after which they will reconfigure into smaller, scattered outbreaks. “Extensive mosquito control efforts would make a difference,” he says. “Much of South America had made great strides here, but then the mosquito control programs were allowed to lapse in the mid- to late 20th century, and the mosquitoes made a comeback.”