Pandemics are not new, nor is society’s attention to the social determinants of health. Fortunately, science has progressed, bringing public health measures including infection control, appropriate sanitation, wholesome environments, and most recently, the miracle of effective vaccines to society in record time.
The common thread among the innovations is advancing from merely admiring the problem to actively addressing the cause. The term “social multipliers” captures the change from passive observation to active intervention. Unfortunately, the challenge of improving and distributing the social multipliers of health equitably across society remains unsettling. Historical examples abound.
The article History of Cholera states, “Famous public health milestones extend back to cholera in 19th century London. Cholera was one of the deadliest diseases to affect Britain in the nineteenth century with the fourth and final pandemic in London in 1866. In the nineteenth century, it was believed that the disease was transmitted and spread by a ‘bad air’ or ‘bad smells’ from rotting organic matter.
Britain enacted several actions to help curb the spread of the disease, including implementing quarantines and establishing local boards of health. But the public became gripped with widespread fear of the disease and distrust of authority figures, most of all doctors.
In 1853–54, London's epidemic claimed 10,739 lives. The 1854 Broad Street Cholera outbreak in London ended after the physician John Snow identified a neighborhood Broad Street pump as contaminated and convinced officials to remove its handle to prevent people from drawing water there.”
London was not the only epicenter or birthplace of public health. Rudolf Virchow (1821-1902) created a moral understanding of public health that culminated in German Emperor Bismarck challenging him to a duel. At age 26 Virchow was sent by the government to Upper Silesia, now modern-day Poland, to investigate “relapsing fever,” according to a
Moral Understanding of Public Health.
Virchow reported back that the impoverished people lived on potatoes and vodka while suffering from malaria and dysentery. Virchow correctly blamed the abysmal social conditions and was proven correct forty years later when the vector was proven to be lice. “Epidemics of illness usually occur after social upheavals, in the ensuing overcrowding, poor hygiene, and malnutrition,” Virchow wrote in his report.
Science, epidemiology, and a “head’s up” physician, Dr. Snow, saved a community by changing its environment, namely how water was obtained. Dr. Virchow, more famous for medical contributions to cellular pathology and the etiology of clots, actually codified a fundamental law of epidemiology: “If disease is an expression of individual life under unfavorable conditions, then epidemics must be indicative of mass disturbances of mass life.”
Nowadays, nudging folks to healthier behaviors has the same positive effect but may not be as dramatic. Accurately measuring life expectancy has shown similar meaningful results. For example, Southwest Florida added 0.6 years of life expectancy since 2015 as measured by the University of Wisconsin Population Department when the Blue Zones Project was initiated in the region.
Physicians and scientists, then and now, have had significant positive influences for society. Although not always well accepted at first, ultimately, the good that persists carries the day.