‘F’ in Public Health 101

The United States has an internationally respected “rapid-response system” for detecting and treating infectious diseases, as most Americans know through nonfiction thrillers like Richard Preston’s “The Hot Zone.” That book dramatized how the federal Centers for Disease Control quickly contained a deadly virus after it escaped into a lab in Reston, Va., in 1989.

However, it’s less well known that the nation has no system at all for tracking widespread but more subtle chronic syndromes--from developmental disabilities to asthma and slowly progressing illnesses like cancers, Alzheimer’s and Parkinson’s.

We don’t know, for instance, why the reported incidence of autism and mental retardation has risen 50% nationwide in the last decade. Is it better reporting or an actual increase in the rate? Why did the rate of asthma increase 75% in California between 1984 and 1998?

Epidemiologists suspect that these clusters of chronic conditions are caused by some combination of genetic inheritance and environmental toxins like air pollution or household pesticides. However, they are unable to prove their supposition because the United States has no mechanism for monitoring how often chronic diseases or conditions occur, whom they afflict, where they occur most frequently and the environmental influences that may trigger them. The United States, in short, is failing Public Health 101.

Congress is now considering amendments to pending bills in the House and Senate that could improve the nation’s aptitude. The measures ask the Centers for Disease Control to begin setting up a chronic disease monitoring system--specifically, a federal, state and local rapid-response network that would investigate clusters, outbreaks and emerging threats of chronic disease.

A study released last week by the Pew Environmental Health Commission estimates that the cost of developing such a system could reach $275 million yearly. However, the system would enable doctors to identify chronic diseases early on and in some cases diminish their damage.

One example of how much chronic disease monitoring can accomplish is the Framingham Heart Study, a federal inquiry into why U.S. heart disease and stroke rates were skyrocketing. The study, begun in 1948, identified virtually all of the factors that are recognized today as the major causes of heart disease. Taking aim at the steak, butter and eggs newly abundant on the postwar table, the study raised awareness of the risks of cholesterol and sedentary lifestyles, launching prevention campaigns that have since significantly reduced risks of both heart disease and stroke.

Congress is unlikely to come up with $275 million, but it should at least affirm the need to take preliminary steps in chronic disease monitoring.

The chairman of the Pew commission, former Sen. Lowell P. Weicker Jr. (R-Conn.), recently observed, “It’s probably safe to say that we know more about how the environment affects fish in our rivers than about how it affects the children living on shore in New York City, Jacksonville or Charleston.”

This is not to say that environmental toxins are necessarily dominant in many chronic disorders. But understanding disease begins with monitoring. Scientists can begin to quantify the impact of environment and genetics on disease only when they have access to a lot more information than they currently have.