Above: Gujarat, India. Half of India’s population, approximately 620 million people, defecates outdoors. Image Courtesy: Emmanuel Dyan
Across the sides of city buses in my home province of Alberta, Canada, there are advertisements with snips of newspaper articles from decades ago referencing the devastation caused by outbreaks of polio and whooping cough in Alberta. A campaign initiated by Alberta Health Services, the headline on these ads reads “Keep the past where it belongs”.
Alberta’s concern for immunization is not ungrounded. According to a recent article in the Canadian magazine The Walrus, it is becoming more common to find small groups of Canadians with lower immunization rates than the general population. At least five provinces, including Alberta, have experienced a measles outbreak this year. Such diseases are making a sneaky comeback. As Canada has not experienced endemic measles since 1998, the recent outbreaks are largely attributed to individuals who are not vaccinated contracting measles while traveling abroad and transmitting the virus to members of their communities upon returning home. These members include children too young to have yet received their routine vaccinations, making infants the most vulnerable to this highly contagious disease.
Since most routine vaccinations are administered in infancy and childhood, it is parents who decide whether or not their children will receive vaccines for diseases such as measles, diphtheria, whooping cough, tetanus, polio and meningitis. Motivated by fears that vaccines cause troubling health complications, some parents are choosing not to vaccinate their children, demonstrating that the perceived harm of vaccines for some has become greater than that of the disease the vaccine intends to prevent. We may argue that vaccines have become their own worst enemy, and that it is because of their success that we no longer perceive these diseases as life-threatening, or even as a threat at all.
As with any medical procedure, we as the general public rely on giving “informed consent,” trusting that we have been made aware of all of the possible risks associated with the procedure we are about to undergo. But as Margaret Somerville from the Centre for Medicine, Ethics and Law at McGill University points out, informed consent also includes the possible risks associated with not undergoing that procedure. Furthermore, these risks extend beyond the health of the individual to include the health of his or her community. Whether we know it or not, when we assess health risks and make decisions regarding our personal health, such as choosing whether or not to vaccinate our children, we are also making public health decisions and assessing public health risks.
We see this assessment of public and private risk in many modern public health challenges. Take, for example, the response of the international community to the Ebola outbreak in West Africa. The enforcement of mandatory quarantine of medical workers who are returning home from helping abroad with the crisis has become a controversial issue after a US doctor was diagnosed with Ebola days after his return home. While some feel that mandatory quarantine is the best way to ensure public safety, others feel that quarantine is unnecessary, even “inhumane” for those workers who do not display symptoms of the virus, and that the decision was made from a state of fear that is not justified. Taking an even stronger stance, some countries, including Canada, have decided to suspend visas of residents from Ebola affected countries, closing the border to these populations altogether.
Given the difficulty of weighing the risks associated with public health concerns, how are we to choose the best way to protect ourselves, our children, and our local and global communities from infectious disease? Individual and personal freedoms play an important role here, since we value exercising the right to choose what to do with our bodies, including the risks that we choose to expose ourselves to. We may not support decisions that make us feel as if our individual freedoms are jeopardized to protect the public. However, our perceived personal freedoms may not be as personal as we think they are. Our individual choices do affect others, just as the individual choices that others make affect us.
Our misguided efforts at self-protection become obvious in densely populated areas. Recent malnutrition and poor sanitation research, exhibited at the conference “Stop Stunting” held in India this month, demonstrates this. Mentioned in a New York Times article, the open defecation practices in India affect not only populations without toilets, but also those who have appropriate household sanitation. Summarizing Dr. S V Subramanian, a Harvard professor who attended the conference, even the wealthy suffer from stunting: “Even if they have toilets at home, they live near others who do not and can be infected by bacteria carried by flies and water.”
Understanding that our personal choices do not exist independently of a greater social consequence is paramount to improving the health of our communities, and we must acknowledge that there is not a clear line that distinguishes the two. As we find ourselves dwelling in a world that is more and more globalized, we will find that we are only as healthy as our communities. International travel has never been so easy, urban populations are growing and our use of resources in one area has the capacity to devastate populations in an other. Making informed decisions regarding private health concerns, thus making public health a private priority, may yield the best results for everyone. In fact, it most certainly will.
-Sangie Zaitsoff | Grants Officer